Aviation Safety, Security Aviation Safety, Security & the Environment: The & the Environment: The
Way ForwardWay Forward
Vince GalottiVince GalottiChief/Air Traffic ManagementChief/Air Traffic Management
ICAOICAO
Safety and EfficiencySafety and EfficiencyAn ICAO PerspectiveAn ICAO Perspective
Presentation OutlineTwo issues
Evolution of ICAO’s efforts toward a more seamless and global ATM system
Safety Management
CONTINUED EVOLUTION TOWARD A MORE GLOBAL AND SEAMLESS ATM SYSTEMGlobal ATM Operational Concept
Provides the ICAO vision of seamless, global ATM system Endorsed by 11th ANCONF SESAR and NexGen are adapting the concept
Performance Based Transition Global Air Navigation Plan
23 Global Plan InitiativesStems from industry roadmapAssists in establishment of performance objectivesAssists in implementation of ATM operational
improvements
4
Safety Management
How do we ensure safety in the more complex, synchronized global system that we strive toward
How do we ensure safety in the more complex, synchronized global system that we strive toward
5
The evolution of safety thinking
TECHNICAL FACTORSTECHNICAL FACTORS
HUMAN FACTORSHUMAN FACTORS
ORGANIZATIONAL ORGANIZATIONAL FACTORS FACTORS
TOD
AY
TOD
AY
1950s1950s 1970s1970s 1990s1990s 2000s2000s
6
Concept of safety
The elimination of accidents (and serious incidents) is The elimination of accidents (and serious incidents) is unachievable. unachievable.
Failures will occur, in spite of the most accomplished Failures will occur, in spite of the most accomplished prevention efforts.prevention efforts.
No human endeavour or human-made system can be No human endeavour or human-made system can be free from risk and error. free from risk and error.
Controlled risk and error is acceptable in an inherently Controlled risk and error is acceptable in an inherently safe system.safe system.
The elimination of accidents (and serious incidents) is The elimination of accidents (and serious incidents) is unachievable. unachievable.
Failures will occur, in spite of the most accomplished Failures will occur, in spite of the most accomplished prevention efforts.prevention efforts.
No human endeavour or human-made system can be No human endeavour or human-made system can be free from risk and error. free from risk and error.
Controlled risk and error is acceptable in an inherently Controlled risk and error is acceptable in an inherently safe system.safe system.
7
Concept of safety (Doc 9859)
SafetySafety is the state in which the risk of harm to persons
or property damage is reduced to, and maintained at or
below, an acceptable levelacceptable level through a continuing
process of hazard identificationhazard identification and risk risk
management. management.
SafetySafety is the state in which the risk of harm to persons
or property damage is reduced to, and maintained at or
below, an acceptable levelacceptable level through a continuing
process of hazard identificationhazard identification and risk risk
management. management.
8
The management dilemma
ProductionProtectionProtection
ResourcesResourcesManagement levels
9
The big picture
Operation of aircraftOperation of aircraftMaintenance of aircraftMaintenance of aircraftAir traffic services Air traffic services AerodromesAerodromes
Two audience groupsTwo audience groupsStatesStatesService providersService providers
Three distinct requirementsThree distinct requirementsSafety programmeSafety programmeSMSSMS Management accountabilityManagement accountability
Operation of aircraftOperation of aircraftMaintenance of aircraftMaintenance of aircraftAir traffic services Air traffic services AerodromesAerodromes
Two audience groupsTwo audience groupsStatesStatesService providersService providers
Three distinct requirementsThree distinct requirementsSafety programmeSafety programmeSMSSMS Management accountabilityManagement accountability
10
As of 23 November 2006
States shall establish a States shall establish a safety programmesafety programme, in order to , in order to achieve an achieve an acceptable level of safetyacceptable level of safety in: in:The operation of aircraft The operation of aircraft The maintenance of aircraft The maintenance of aircraft The provision of air traffic services The provision of air traffic services Aerodrome operationsAerodrome operations
The acceptable level of safety to be achieved shall be The acceptable level of safety to be achieved shall be established by the State(s) concernedestablished by the State(s) concerned
States shall establish a States shall establish a safety programmesafety programme, in order to , in order to achieve an achieve an acceptable level of safetyacceptable level of safety in: in:The operation of aircraft The operation of aircraft The maintenance of aircraft The maintenance of aircraft The provision of air traffic services The provision of air traffic services Aerodrome operationsAerodrome operations
The acceptable level of safety to be achieved shall be The acceptable level of safety to be achieved shall be established by the State(s) concernedestablished by the State(s) concerned
11
What is a safety programme?
An integrated set of regulations and activities aimed at An integrated set of regulations and activities aimed at improving safety.improving safety.
States are responsible for establishing a safety States are responsible for establishing a safety programme:programme:Safety regulationSafety regulationSafety oversightSafety oversightAccident/incident investigationAccident/incident investigationMandatory/voluntary reporting systemsMandatory/voluntary reporting systemsSafety data analysis and exchangeSafety data analysis and exchangeSafety assuranceSafety assuranceSafety promotionSafety promotion
An integrated set of regulations and activities aimed at An integrated set of regulations and activities aimed at improving safety.improving safety.
States are responsible for establishing a safety States are responsible for establishing a safety programme:programme:Safety regulationSafety regulationSafety oversightSafety oversightAccident/incident investigationAccident/incident investigationMandatory/voluntary reporting systemsMandatory/voluntary reporting systemsSafety data analysis and exchangeSafety data analysis and exchangeSafety assuranceSafety assuranceSafety promotionSafety promotion
12
As of 23 November 2006
States shall require, as part of their safety programme, that States shall require, as part of their safety programme, that an an [operator, maintenance organization, ATS provider, [operator, maintenance organization, ATS provider, certified aerodrome operator]certified aerodrome operator] implements a implements a safety management system accepted by the State that, as a accepted by the State that, as a minimum:minimum: Identifies safety hazardsIdentifies safety hazards Ensures that remedial action necessary to maintain an Ensures that remedial action necessary to maintain an
acceptable level of safety is implemented acceptable level of safety is implemented Provides for continuous monitoring and regular Provides for continuous monitoring and regular
assessment of the safety level achievedassessment of the safety level achieved Aims to make continuous improvement to the overall Aims to make continuous improvement to the overall
level of safetylevel of safety
States shall require, as part of their safety programme, that States shall require, as part of their safety programme, that an an [operator, maintenance organization, ATS provider, [operator, maintenance organization, ATS provider, certified aerodrome operator]certified aerodrome operator] implements a implements a safety management system accepted by the State that, as a accepted by the State that, as a minimum:minimum: Identifies safety hazardsIdentifies safety hazards Ensures that remedial action necessary to maintain an Ensures that remedial action necessary to maintain an
acceptable level of safety is implemented acceptable level of safety is implemented Provides for continuous monitoring and regular Provides for continuous monitoring and regular
assessment of the safety level achievedassessment of the safety level achieved Aims to make continuous improvement to the overall Aims to make continuous improvement to the overall
level of safetylevel of safety
13
What is an SMS?
A systematic approach to A systematic approach to managing safety, including managing safety, including the necessary organizational the necessary organizational structures, accountabilities, structures, accountabilities, policies and procedures.policies and procedures.
Providers are responsible for Providers are responsible for establishing an SMS.establishing an SMS.
States are responsible of the States are responsible of the acceptance and oversight for acceptance and oversight for providers’ SMS.providers’ SMS.
A systematic approach to A systematic approach to managing safety, including managing safety, including the necessary organizational the necessary organizational structures, accountabilities, structures, accountabilities, policies and procedures.policies and procedures.
Providers are responsible for Providers are responsible for establishing an SMS.establishing an SMS.
States are responsible of the States are responsible of the acceptance and oversight for acceptance and oversight for providers’ SMS.providers’ SMS.
14
As of 23 November 2006
An accepted safety management system shall clearly An accepted safety management system shall clearly define define lines of safety accountabilitylines of safety accountability throughout the throughout the [airline, maintenance, ATS provider, certified aerodrome [airline, maintenance, ATS provider, certified aerodrome operator] operator] organization, including organization, including direct accountability direct accountability for safety on the part of senior management.for safety on the part of senior management.
Note. – Guidance on safety management systems is Note. – Guidance on safety management systems is contained in the ICAO Safety Management Manual contained in the ICAO Safety Management Manual (Doc 9859).(Doc 9859).
(Accountability – Obligation or willingness to account for (Accountability – Obligation or willingness to account for one’s actions) one’s actions)
An accepted safety management system shall clearly An accepted safety management system shall clearly define define lines of safety accountabilitylines of safety accountability throughout the throughout the [airline, maintenance, ATS provider, certified aerodrome [airline, maintenance, ATS provider, certified aerodrome operator] operator] organization, including organization, including direct accountability direct accountability for safety on the part of senior management.for safety on the part of senior management.
Note. – Guidance on safety management systems is Note. – Guidance on safety management systems is contained in the ICAO Safety Management Manual contained in the ICAO Safety Management Manual (Doc 9859).(Doc 9859).
(Accountability – Obligation or willingness to account for (Accountability – Obligation or willingness to account for one’s actions) one’s actions)
15
Safety programme – SMS relationships
Statesafety
programme
Organization’ssafety
management system (SMS)
Organization’sproductionprocesses
Objective:Publicsafety
Objective:Manage and controlsafety risk
AcceptanceOversight
Objective:Achieve commercialgoals andcustomer satisfactionRisk management
Safety assurance
Protection Production
Oversight
16
The essential is invisible to the eyes
Number of occurrences
1 – 5 AccidentsAccidents
30 – 100 Serious incidentsSerious incidents
100 – 1000 IncidentsIncidents
1000 – 4000 Latent conditionsLatent conditions
17
Strategies – Levels of intervention and tools
Baseline performanceBaseline performance
“Practicaldrift”
Operational performance
Operational performance organization
Predictive Proactive Reactive
Highly efficient Very efficient Efficient
Safety management levelsSafety management levels
Reactive
Desirable managementDesirable managementlevel level
Insufficient
ASRASRSurveysSurveysAuditsAudits
ASRASRMORMOR
AccidentAccidentand incidentand incident
reportsreports
HHiigghhMMiiddddllee
LLooww
HazardsHazards
FDAFDADirectDirect
observationobservationsystemssystems
18
Risk mitigation at a glance
Does the mitigation address the hazard?
Does it address the risk(s)?
Is it appropriate? Is it effective?
Assessment of the defences within
the safety system
R RR R
Accepting the mitigation of
the risk
H H H H
Hazard identificationand
risk management
Control and mitigation
of the risk (s)
Is additional or
mitigation warranted?different
EACH HAZARD
Regulations
Training
Technology
Do the mitigationstrategies generateadditional risk(s)
EACH RISK
ALARP
Intolerable region
Acceptable region
Tolerable region
Feedback (Safety assurance)
19
Safety culture
A construct
An outcome, not a process
The introduction of safety management concepts lays the foundation upon which to build a safety culture
Safety culture cannot be “mandated” or Safety culture cannot be “mandated” or
“designed”, it evolves.“designed”, it evolves.
It is generated “top-down”It is generated “top-down”
A construct
An outcome, not a process
The introduction of safety management concepts lays the foundation upon which to build a safety culture
Safety culture cannot be “mandated” or Safety culture cannot be “mandated” or
“designed”, it evolves.“designed”, it evolves.
It is generated “top-down”It is generated “top-down”
20
Positive culture
Positiveculture
Flexible culturePeople can adapt
organizational processes when facing high
temporary operations or certain kinds of danger,
shifting from the conventional hierarchical mode to a flatter mode.
Learning culturePeople have the willingness
and the competence to draw conclusions from
safety information systems and the will to implement
major reforms.
Informed culturePeople are knowledgeable about the human, technical,
organizational and environmental factors that determine the safety of the system as a whole.
Reporting culturePeople are prepared to report their errors and
experiences
Just culturePeople are encouraged (even rewarded) for providing
essential safety-related information. However, there is a clear line that differentiates between acceptable and
unacceptable behaviour.
Source: David Marx
21
SummaryThe global ATM system continues to grow rapidlyThe growth will continue (environment?)ICAO works toward a safe and efficient growth
Global ATM operational conceptGlobal Air Navigation plan
New approach to safety Proactive, predictivePerformance basedSAFETY MANAGEMENT SYSTEMS
The global ATM system continues to grow rapidlyThe growth will continue (environment?)ICAO works toward a safe and efficient growth
Global ATM operational conceptGlobal Air Navigation plan
New approach to safety Proactive, predictivePerformance basedSAFETY MANAGEMENT SYSTEMS