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Transcript of Title Page HeliStat™ An Automated Risk Assessment Tool for Helicopter Safety Management Systems...
HeliStat™
An Automated Risk Assessment Tool for Helicopter Safety Management Systems
Alex Richman
AlgoPlus Consulting Limited
Halifax NS Canada
Leonard MacLean
Dalhousie University
Halifax NS Canada
T SEPT 28 Copyright©2005 AlgoPlus Consulting
AbstractSafety Management System (SMS) developers have challenges in:Becoming proactive
Assessing risks systematically
Prioritizing
This presentation describes HeliStat™, a computerized system which automatically performs these functions for mechanical malfunctions (SDR and MMIR) and operational incidents (CADORS)
The Evolution of Safety Culture(and Safety Management Systems)
1. PATHOLOGICALwho cares as long as we’re not
caught
2. REACTIVESafety is important, we do a lot every time we have an accident
3. CALCULATIVEwe have systems in place to
manage all hazards
4. PROACTIVEwe work on the problems that
we still find
5. GENERATIVEsafety is how we do business
round here
Increasing vigilance for
potential hazards
Systematic knowledge about operation of system as a whole.
Adapted from Hudson , Leiden Univ, 2004
SMS requires Data
SMS ImplementationThere are multiple approaches to SMS
Transport Canada’s Guide is more detailed than others in specifying the process (TP14343)
Phase 1: Plans and procedures
Phase 2: Reactive system (3.1)
Capture internal data
Monitor/analyze trends
Phase 3- Proactive hazard identification from external sources(3.2)
Risk assessment (3.4)
1. Because of their larger size, system-wide databases are far more likely to yield information about events which might occur later in a smaller fleet
2. Larger data bases are more likely to reveal trends
3. Benchmark comparisons are possible
Advantages of Proactive Analysis
Reactive/ Proactive Dichotomy
Reactive ProactivePost facto Identify potential hazards“Tombstone mentality”Investigation of event
Microscopic
Wariness General analysis of systemMacroscopic
“Smoking gun” Chain of risk factorsForensic cause Probabilistic
Richman & Murphy 2005
Sources for Proactively Identifying Potential Hazards
•Company experience: reports, minutes•Managers’ perceptions•Workforce opinions•Audit reports•Previous hazard analyses•Hazards identified by other organizations
Safety and reliability data recording systems:
CADORS, BASIS
SDR, MMIR
TC TP 1381E
Service Difficulty Reports: •Federal Aviation Administration and Transport
Canada•Mandated•“Mechanical problems, defects, malfunctions affecting safety”
Mechanical Malfunction Information Reports:•Helicopter Association International •Voluntary•Broad definition
Web sites are useful for locating specific reports but are less useful for risk assessment and trend assessment
SDR and MMIR Reports:Mechanical and Maintenance
Questions about Safety-Significant Events (SSE)
• Are there significant increases over time? • Are SSEs “consistent” over time (SPC)?• Which SSEs are more severe and more likely to
occur (risk assessment)?• Are SSEs more likely in one model or operator?• Are there historically unusual SSEs?• Which SSEs should have more priority for further
attention?• How can we identify SSE precursors ?
GAIN Initial Survey of 15 Safety Officers
– Too much time spent on routine tasks
– Little time for proactive safety efforts
– Follow-up is not always well tracked
– Need outside benchmarking
– Need better analytical tools
– Clear safety strategy infrequent (1/15)
Problems in SMS Analyses
•Complexity of data preparation and updating
•Difficulties in integrating data and software into IT infrastructure
•Need for computer proficiency
•Acquiring analytic skills
•Lack of time
Lots to Do: Too Little Analysis
• Easy to use
• Contain proactive data bases
• Identify hazards and assess risks(Likelihood, severity, trends)
• Indicate priorities
• Generate documentation
• Monitor system continually
SMS Software Requirements
Continuous Monitoring and Automated Analysis
• (Morningstar is a financial example)– Continuous monitoring of updated databases
– Near-real-time reporting of updates to benchmarks, trends, rankings, priorities
– – “Pushes” analytic results to user
– Very user-friendly for SMEs
HeliStat™ uses this model•
What is HeliStat™?
A subscription service
for web-based analyses
of mechanical malfunctions
reported to the FAA- Service Difficulty Reports
and to Helicopter Association International’s
Mechanical Malfunction Information Reports
TM
HeliStat™ is Designed for Aviation Specialists Without
Data Analytic Skills
HeliStat™
• Incorporates multiple databases SDR/MMIR• Near-real-time data• Uses census denominators • Compares models/operators with industry wide
benchmarks • Model specific • Source data accompanies analyses• Prioritizes problems• Shares and tracks reports
HeliStat™ is a System
E-mail list formodel by JASC
1
Threat Matrix2
Sourcereport3
Share Report4
Out mail list5
Priority ALERTS in E-mail
A. Risk assessment traffic light summarizes Threat MatrixB. PrioritizedC. Recent reports, past 5 weeksD. Reports not yet viewed
A
BD
C
Systematically DefinedRisk Matrix
RelativeLikelihood
Significantly aboveaverage
Below average
HazardMinimal Increased
Reliable and ObjectiveRisk Matrix Calculation:
•Relative likelihood of occurrence:
Rate in the specified model Benchmark rate for all the other models
•Hazard is derived from the FAA Severity score for specific ATA/JASC codes and the Flight Safety Foundation’s CARE project for classifying “Nature of Condition” and “Precautionary Procedures” in SDRs
3 Graphs Combined to Show Time Trends
Time Trends in One Risk Assessment Matrix
Risk Matrix Summarized in Traffic Lights
•Relative likelihood•Hazard level•Time Trends•Recent Increase
Risk Matrices forIndividual Parts
• No limit on number of parts
Individual Narrative Reportsfor 6 Months
Historically Unusual Events:Unique, First, Rare, Cluster
HeliStat™ Overcomes Many Pitfalls
in Risk Assessment
• Objective, quantitative assessment • Specified time span • Indicates trends over time - trajectory • States nature of the hazard • Shows source narratives• Automated without specialist assessment• Sensitive to short-term changes• Continuous monitoring
HeliStat™ System for Sharing Reports
The user can e-mail the JASC threat matrix to otherswithin the organization.
The recipient has full access to all linked data for this JASC only
HeliStat™ Share Message
The sender can state why s/he is sending this report, ask a specific question or request a general comment.
ALERT keeps track for the sender:•Recipient •ATA/JASC code•Model•Date sent•Date opened
Unopened link
HeliStat™ Maintains Out-Mail List and Tracks Recipients’ Opening Dates
HeliStat™ Enables Early Decision Making
1. For the model and each ATA/JASC component HeliStat™ gives the user :
• Priority traffic light
• Risk assessment matrix
• Time trends
• Historically unusual occurrences
• Source narratives
2. Users have more time to target their activity
and to explore source data
HeliStat™ Analyses Give More Time for SMEs
to Use Expertise
Possible Reactions to HeliStat™ Information
• Problem already known and taken care of• Check fleet now/soon• Consider preventive suggestion• Modify procedure: installation/inspection• Modify inspection: method or frequency• Recommend as audit topic• Place on MEL • Await further information, tickle
HeliStat™- Features• Point and click – no programming required• Push technology- subscriber specifies model,
frequency of reports• Mechanical problems affecting safety in 2 data
bases(SDR, MMIR)• Near real time- reports daily, weekly, monthly• E-mail for newly reported events, • Risk matrices for ATA/JASC system – 488 codes• Trajectory: likelihood and severity over 3 time periods• Likelihood rates compared to system-wide benchmarks• Likelihood and hazards quantified• Past history since 1/1/1996• Narratives of reports for past 182 days
SMS becomes more effective when HeliStat™ overcomes SMS challenges for :
• Becoming proactive
• Risk assessment
• Prioritization
Making SMS more effective helps move the organization towards achieving a safety culture
HeliStat™ Helps a Safety Culture Evolve Faster
HeliStat™ References
1. Rotor magazine (Winter 2004-2005, 42-43
2. Air Beat (January-February 2005), 42-43
3. Aviation Maintenance, December 2004, 34
4. Air Safety Week, September 27, 2004
5. www.helistat.com
AlgoPlus Consulting Limited
Suite 3085670 Spring Garden RoadHalifax, NS, Canada B3J 1H6http://www.helistat.com
fax: 1-902-484-7061email: [email protected]
telephone: 1-902-423-5155 1-888-ALGOPLUS
Questions ?