safety management system seminar for nam/car/sam regions ats safety management mexico city, 14–16...
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Safety Management System Safety Management System Seminar for NAM/CAR/SAM RegionsSeminar for NAM/CAR/SAM Regions
ATS safety management
Mexico City, 14–16 March 2006
International Civil Aviation Organization North American, Central American and Caribbean Regional Office
ATS safety management
ICAO purposes, strategic objetivesStates responsabilityICAO requirements, Annex 11 (ATS)ATS safety management programsQuality Assurance programmeRisk measureSafety cultureNext stepsATM performance
ICAO purposes
Safety has always been the most important issue in all aviation activities.
This is reflected in the aims and objectives of ICAO as stated in Article 44 of the Convention on International Civil Aviation (Doc 7300), which charges ICAO with ensuring the safe and orderly growth of international civil aviation throughout the world.
ICAO STRATEGIC OBJECTIVES (for the period 2005-2010)
Adopted by Council on 17 December 2004
ICAO works to achieve its vision of safe, secure and sustainable development of civil aviation through cooperation amongst its member States.
To implement this vision, the Organization has established the following Strategic Objectives for the period 2005-2010:
A: Safety - Enhance global civil aviation safetyB: Security - Enhance global civil aviation securityC: Environmental Protection - Minimize the adverse effect of
global civil aviation on the environmentD: Efficiency - Enhance the efficiency of aviation operationsE: Continuity - Maintain the continuity of aviation operationsF: Rule of Law - Strengthen law governing international civil
aviation
The State responsibility
The State, as the signatory to the Chicago Convention, is responsible for providing a regulatory safety framework for implementation of ICAO SARPS within the airspace and at aerodromes for which it has responsibility in accordance with the basis of the safety management requirements
Where a State is also an ATM service provider:
It is important keep clear distinction between the regulatory functions and the service provision functions
The regulatory division must maintain effective safety oversight of the ATM service provisions
ICAO Requirements
ATS Safety Management
In 2001 provisions relating to safety management were introduced in Annex 11.
Annex 11 contains provisions regarding the establishment of ATS safety management programms, and includes a requirement to establish objetives and acceptable level of safety.
Complementary procedures also were introduced in the Doc 4444, PANS-ATM. (November 2003)
Additionally, new Standards and Recommended Practices (SARPS) related to Safety Management System will be introduced accordingly.
ATS Safety Management
Implementation of ATS safety management programs refers to the day to day keep safety oversight management by the ATS service providers
States shall establish systemic and suitable ATS safety management programs with defined levels and objectives
As appropriate, target levels of safety (TLS) will be established through regional air navigation agreement
Prior to any significant change to the safety-related ATC system, a safety assessment will be carried out, proving that an acceptable safety level may be obtained
ATS Safety Management
The acceptable level of safety may be specified in qualitative or quantitative terms.
a) a maximum probability of an undesirable event, such as collision, loss of separation or runway incursion;
b) a maximum number of accidents per flight hour;
c) a maximum number of incidents per aircraft movement;
d) a maximum number of valid short-term conflict alerts (STCA) per aircraft movement.
ATS safety management programme
Shall:
identify actual and potential hazards and determine the need for remedial action;
ensure that remedial action necessary to maintain an acceptable level of safety is implemented; and
provide continuous monitoring and regular assessment of the safety level achieved.
ATS Safety Management…
Monitoring of safety levels actual or potential safety hazards or deficiencies
related to the provision of ATS,
procedures, communications, navigation and surveillance systems and other safety significant systems and equipment as well as controller work loads
Collection and evaluation of safety-related data
Review of incidents and
Other safety-related reports
ATS Safety Management…
Safety reviews
training, experience and expertise;
full understanding of SARPs, PANS, safe operating practices and
Human Factors principles
Regulatory, operational and technical framework
ATS … Safety Assessment
Safety Assessment calculates the risk of accidents index
Required full commitment of States, ATS providers and users as well as Operators
If safety meets expected levels then change is feasible
ATS … Safety Assessment
The safety assessment is a systematic approach, as whole criteria to evaluate the acceptability of the risk and severity: the safety assessment process needs to address both factors.
If the initial assessment of the risk indicates that it does not satisfy the safety assessment criteria, requiring the introduction of mitigation measures, it will be necessary to re-evaluate the risk in order to determine the mitigation measures for the desired effect.
It means that some of the previous steps should be repeated; the process may, in fact, need to be repeated more than once, until a satisfactory combination of mitigation measures is found.
Have proved to be an efficient tool fostering the establishment of diverse complementary programmes for the assessment of ATS performance (units, ATCOs) such as;
verification and training for ATC proficiency
incident reporting and investigation
verification on the use of aeronautical phraseology
incident prevention measures
Quality improvements
Safety management
evolutes to systemic approach of ATM performance
ATS Quality Assurance Program
Risk measure expressed in terms of fatal aircraft accidents are indicators of individual risk, since they do not take account of the number of people affected.
A risk measure expressed in terms of number of fatalities would be more appropriate for expressing societal risk.
Acceptability is usually based on comparison with a severity/probability matrix
An acceptable limit expressed in terms of incidents would be significantly different from a limit expressed in terms of fatal aircraft accidents.
Risk measures
RISK CLASSIFICATION SCHEME
Probability of Occurrence
Extremely improbable
Extremely remote RemoteReasonably
probableFrequent
Severity Catastrophic
Review Unacceptable Unacceptable Unacceptable Unacceptable
Hazardous
Review Review Unacceptable Unacceptable Unacceptable
Major
Acceptable Review Review Review Review
Minor
Acceptable Acceptable Acceptable Acceptable Review
Classification of safety occurrences and causal factors
It is much easier if events and causal factors are classified using a standard scheme and the classified data, called a taxonomy, is comprised of a hierarchy of classes of events.
ICAO has, maintained a global data base of accidents and serious incidents notified by States through the Aircraft Accident Data Reporting System (ADREP), which, contains a greatly expanded taxonomy of ATS-related categories (http://eccairs-www.jrc.it/)
Taxonomies should be used for classification of ATS-related safety occurrence data for internal investigation and analysis purposes, as well as for reporting accident and incident data to ADREP.
Sharing information online for the classification of risk and the suitable measures to its solution; regional collaboration for the harmonization and exchange of experience
Positive safety culture
a) Senior management place strong emphasis on safety as part of the strategy of controlling risks;
b) Decision-makers and operational personnel hold a realistic view of the short- and long-term hazards involved in the organization’s activities;
c) Those in senior positions: 1) Foster a climate in which there is a positive attitude towards
criticisms, comments and feedback from lower levels of the organization on safety matters;
2) Do not influence /force their views on subordinates; and 3) Implement measures to contain the consequences of
identified safety deficiencies;
d) Senior management promote a non-punitive working environment (not immunity);
e) There is an awareness of the importance of communicating relevant safety information at all levels of the organization (within and outside);
f) There are realistic and workable rules relating to hazards, to safety and to potential sources of damage;
g) Personnel are well trained and understand the consequences of unsafe acts.
h) There is a low incidence of risk-taking behaviour, and a safety ethic which discourages such behaviour
Positive safety culture
Characteristics of different safety cultures
Safety Culture:
Characteristics
Poor Bureaucratic Positive
Hazard information is: Suppressed Ignored Actively sought
Safety messengers are: Discouraged or
punished
Tolerated Trained and
encouraged
Responsibility for safety is: Avoided Fragmented Shared
Dissemination of safety
information is:
Discourage Allowed but
discouraged
Rewarded
Failures lead to: Cover ups Local fixes Inquiries and
systemic reform
New ideas are: Crushed New problems (not opportunities)
Welcomed
Next steps…
Uniform system safety approach in accordance with the AN-conf/11 outcomes
Globally standardized implementation of safety management processes and practicesAvoids unnecessary duplicationCollect right data to monitor level of
safety
Broader view of ATM system expectations
ATM community (Doc 9854)
Aerodrome community Airspace providers Airspace users ATM service providers
a) State agencies;b) State-owned self-financing corporations;c) privatized ATM service providers;d) regional ATM service providers; ande) independent private sector ATM service providers of ground and
space-based CNS/ATM services ATM support industry International Civil Aviation Organization (ICAO) Regulatory authorities States
ATM Performance
When the ATM system delivered trajectory equals the user preferred trajectory, the ATM system is operating well
Value is created when the ATM system consistently and cost-effectively delivers User Preferred Trajectory
ATM Performance framework..
Enhancements to safety, finances and the efficiency through the adoption of collaborative decisions towards the evolution of a holistic and co-operation environment should be facilitated to fulfill the expectations of the ATM community, as well as to improve safety of all the system in a balanced manner
Future ATM system must be based on Performance indicators and user expectations:SafetyCapacityEfficiencyRegularityFlexibility
ATM performance metrics
New guidance material on measuring performance and productivity includes an approach to development of performance metrics in the areas of safety, delay, flight efficiency, productivity and cost-effectiveness.
Comparing different organization’s performance might be benefit to understand performance drivers and shortfalls and thus establishing best practices.
ATM Requirements and Performance Panel (ATMRPP) is working to finalize a set of ATM system requirements that will guide development of technical SARPs for ATM research, development, and implementation planning activities.