mems maintenance error management system · • a lead person and a mentor outside the company •...
TRANSCRIPT
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MEMS Maintenance Error Management System
A Culture change within the Maintenance environment by implementing a Error management system.
This is how we did it.
The reality of actually ‘doing safety’ extends beyond the matrices and risk registers and plays itself out in the decision making and behaviours of people throughout the operation on an hour by hour basis. Neil Richardson, Principal Consultant, Baines Simmons
Culture (/ˈkʌltʃər/) is defined as the social behavior and norms found in human societies.
William Smith
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• “How many mistakes do you make every year ” in the Hangar ….“None” , we do not brake aircrafts , Pilots do.. We fix them.!
• “Interesting, anyway, do you know that Errors are manageable….!
• This was the start in 2003.
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• A Lead person and a “mentor “ outside the Company
• A reporting system, reporting all discrepancy in the hangar
• Investigation group 4- 6 members , using the “Meda” form.
• We got 136 reports into the system, of witch 65 we could use.
• ½ year of examination, looking for Contributing factors
• Came out with 13 Key changes we could use, still 3-7 is the Min max.
• We decide to use 5.
The recipe..
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Key Points to make it work.
Power full launch-back to the Hangar
Here you have the result of your reporting
This is not rocket science, all about basic drift from the norm that we all where learned from day one.
From now on this , is how you behave in our hangar.
Enjoy .
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• A Lead person and a “mentor “ outside the Company
• A reporting system, reporting all discrepancy in the hangar
• Investigation group 4- 6 members , using the “Meda” form.
• We got 136 reports into the system, of witch 65 we could use.
• ½ year of examination, looking for Contributing factors
• Came out with 13 Key changes we could use, still 3-7 is the Min max.
• We decide to use 5.
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Thank you.
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Fj
Fleet