Safety Management Initiatives in Shipping 1st Edition 2016 All rights reserved. No part of this publication may be reproduced in any material form (including photocopying or storing it in any medium by electronic means and whether or not transiently or incidentally to some other use of this publication) without the written permission of INTERTANKO. Applications for INTERTANKO’s written permission to reproduce any part of this publication should be addressed to the publisher. © INTERTANKO 2016 Whilst every effort has been made to ensure that the information contained in this publication is correct, neither the authors nor INTERTANKO can accept any responsibility for any errors or omissions or any consequences resulting therefrom. No reliance should be placed on the information or advice contained in this publication without independent verification. ii Safety Management Initiatives in Shipping Foreword Foreword INTERTANKO’s Human Element in Shipping Committee is responsible for promoting and disseminating best practice in the management of people and safety in the tanker industry. As part of the work of the Committee, from time to time initiatives and practices are reviewed and best practice disseminated. This publication was initiated under the outgoing Chair of the Committee, John Adams. The new Chair, Tommy Olofsen, has made publication of such guidance a priority for the Committee. This publication seeks to clarify and explain a range of safety management initiatives available to shipping companies and to discuss the usefulness of these initiatives in achieving improvements in safety performance. Appreciation INTERTANKO notes with appreciation the work of INTERTANKO’s Human Element Committee in the production of this publication and in particular the enormous contribution made by Claire Pekcan of Warsash Maritime Academy and Dr Christine Tomlinson of ABS. Cover image reproduced with kind permission of Teekay. Safety Management Initiatives in Shipping iii Contents Contents Foreword ii 1. Introduction 1 1.1 Scope 2 1.2 Structure of the Publication 2 2. Terminology and Concepts 3 2.1 Safety Management Systems 4 2.2 High Reliability Organisations 6 2.3 Safety Culture and Safety Climate 7 2.4 Safety Maturity 9 3. Measuring Safety Performance 13 3.1 Safety Outcomes 14 3.2 Quality Management 15 3.3 Audits 18 4. Safety Management Initiatives 21 4.1 Safety Climate Surveys 22 4.2 Behavioural-based Safety Management 23 4.3 Crew Resource Management Training 27 4.4 Post-Incident Reviews 32 4.5 Safety Incentive Schemes 37 4.6 Leading Indicators of Safety 40 5. Conclusion 43 6. References 47 Chapter 1. Introduction 2 Safety Management Initiatives in Shipping 1. Introduction International shipping is increasingly the subject of public scrutiny, accountable for how it manages its operations particularly in the light of some recent high-profile maritime casualties. In response to public concern, in 1998 the International Maritime Organization (IMO) adopted a new approach to managing safety when the new Chapter IX of SOLAS, Management for the Safe Operation of Ships, and the accompanying International Safety Management (ISM) Code came into force. In keeping with its non-prescriptive ethos, the ISM Code sets out the requirement for shipping companies to have in place a safety management system, but it does not stipulate the method for achieving satisfactory safety performance. This publication is intended to supplement the requirements of Chapter IX of SOLAS and the ISM Code. Safety management as an activity has advanced, but the absence of prescriptive measures has brought confusion as the terminology and types of initiatives available to companies to manage the risks associated with their operations have proliferated. This publication seeks to demystify the various terms and concepts that have come into use, offers guidance on measuring safety performance, and describes a number of safety management initiatives that an organisation might employ to improve its safety record. As such, it is hoped that it acts as a guide to the concepts, terminologies and practices of safety management. 1.1 Scope This publication explores a range of safety management concepts, mind-sets and methods, but does not cover environmental protection measures. The range of safety management initiatives discussed reflects those most commonly adopted or reported. The publication does not cover technical or engineering related interventions. 1.2 Structure of the Publication First the publication discusses terms and concepts in popular use in the arena of safety management. This chapter explains the concepts, discusses the similarities and differences of concepts, and provides references to additional guidance for those who wish to read further. The third chapter explores the metrics companies can adopt to monitor and measure their safety performance. This chapter differentiates between those performance measures that indicate underlying safety performance – so-called leading indicators – and those measures that are reactive capturing information about past performance of the safety management process. The fourth chapter describes and evaluates a number of safety management initiatives; interventions that companies might implement to improve their safety performance. Chapter 2. Terminology and Concepts 10 Safety Management Initiatives in Shipping There are several models, but two often referred to are those developed by The Keil Centre (Fleming, 2001) and Hudson (Human Engineering, 2005). Both models contain five levels, but Fleming’s model assesses an organisation’s behaviour on 10 elements and emphasises increasing consistency, whereas Hudson’s model assesses behaviour over 18 elements and emphasises increasing trust and ‘informedness’. The two models are described in Table 2.1. LevelFlemingCharacteristic BehaviourHudsonCharacteristic Behaviour 1Emerging• Safety focus is on technical and procedural solutions and compliance with regulations. • Safety not seen as a key business risk. • Safety department perceived as being primarily responsible for safety. • Many accidents seen as unavoidable. • Most frontline staff not interested in safety – only used as a lever on other issues. Pathological• Safety is a problem caused by workers. • The main drivers are the business and a desire not to get caught. 2Managing• Safety seen as a business risk and management time and effort devoted to accident prevention. • Safety focus is on adherence with rules, procedures and engineering controls. • Accidents seen as preventable. • Management perceive that the majority of accidents are solely due to the unsafe behaviour of frontline staff. • Safety performance measured with lagging indicators (e.g. injury rates). • Safety incentives based on reducing loss time incidents. • Senior managers only become involved in health and safety if accidents increase; punishment likely to be used. • Accident rates are near the industry sector average, but tend to have more serious accidents. Reactive• Organisations start to take safety seriously but there is only action after incidents. 3Involving• Accident rates are low, but have reached a plateau. • Organisation realises employee involvement is essential for safety improvement. • Management recognise that a wide range of factors lead to accidents – often stemming from management decisions. • A significant proportion of frontline employees are willing to work with management to improve health and safety. • The majority of staff accept personal responsibility for their own health and safety. • Safety performance is actively monitored and the data used. Calculative• Safety is driven by safety management systems with much collection of data. • Safety is still primarily driven by management and imposed rather than looked for by the workforce. Chapter 3. Measuring Safety Performance 18 Safety Management Initiatives in Shipping quality assurance practices, such as those defined by ISO, can prevent quality standards from slipping but may not necessarily lead to continuous improvements. Furthermore, he argues that audits find errors after the event but do not prevent them; the most effective audit is the one carried out before the activity is undertaken. 3.3 Audits Definition Safety management systems are designed to protect workers’ health and safety, and audits represent one way in which an organisation can assess how well the safety management system (SMS) is working. Audits are a “direct and comprehensive” (Karapetrovic & Willborn, 2001) means of establishing whether the SMS is being implemented as designed and/or whether the SMS is effective in ensuring that people are protected from harm. Audits can either be internal, conducted by company representatives, or external, conducted by third party auditors or inspectors. Essentially, audits form part of the quality management process as they are designed to detect errors and non-conformities. Usually, audits are conducted periodically and represent a ‘sample’ of the workings of the SMS. Not all audits, however, are about assessing conformity. Some forms of audit can also be used as a precursor to change initiatives and used to establish a baseline of the company’s capability in a particular area. This type of audit helps assess how much ‘change’ needs to take place. An example of such an audit would be the Tanker Management and Self Assessment (Oil Companies International Marine Forum, 2008). Audits have a fundamental place in safety management systems. Audits are designed to establish just how often and in what areas performance is in line with what is expected. Falling short of the standard is often referred to as non-conformity and is an indication that the system has failed in some way. A non-conformance is work that has not been performed to the standard expected and has to be corrected or re-done, the customer has to be reimbursed, or a penalty or fine has to be paid to society. Therefore, there are costs associated with non-conformities and these include not only the financial penalties that might need to be paid and the costs in wages, materials and time, but also the cost of lost opportunity, lost enthusiasm and lost customer goodwill. Once the requirements are specified, a process of auditing can be set up to check whether the operation or the ‘system’: 1. is capable of conforming to requirements (capability audit) 2. has the necessary structure and controls in place to meet requirements (management audit) 3. conforms to requirements and the law (compliance audit). Auditing Practice This section briefly discusses auditing practices needed for an International Safety Management (ISM) Code audit. Detailed guidance and training in auditing practice can be found in courses offered by maritime colleges or by classification societies, who also offer auditing services. Guidance on how to conduct an audit is provided in ISO standard 19011:2002. Objectives: The objectives of the auditing process are to verify: • Compliance with codes, standards or regulations • effective implementation of the safety management system Chapter 4. Safety Management Initiatives 22 Safety Management Initiatives in Shipping 4. Safety Management Initiatives In this chapter, safety management initiatives will be described and evaluated. Such initiatives are often referred to as interventions as they are designed to intervene in a company’s current approach to safety and bring about improvements in safety performance in the future. This chapter explains the most common types of interventions implemented in the maritime industry, outlines the fundamental components of the initiatives, and evaluates the effectiveness and limitations of each intervention. Similar interventions are also listed. 4.1 Safety Climate Surveys To encourage participants to take part in the survey, safety climate questionnaires should be kept relatively short, with approximately forty questions that can be answered in fifteen minutes. The announcement of the survey should come from senior management. Participants should be told that whilst the survey is voluntary their participation is sought and valued, that their responses will be anonymous and treated confidentially, and their participation will be undertaken during working hours and at the company’s expense. The questions in such a survey are usually presented as a set of statements to which participants are asked to indicate their level of agreement/disagreement over a five-point scale, known as a Likert Scale. The statements are about operational safety and individual health and safety and can be grouped into aspects of safety climate for analysis. These aspects of safety climate, are called safety factors. As there is no agreed way to segment safety climate, no definitive set of safety factors exists. The safety factors below are those used in the ABS Guidance Notes on Safety Culture and Leading Indicators of Safety (ABS, 2012). The ABS Guidance Notes are used in this publication only as one example. Other entities produce similar guidance that could be used in place of the below ABS Guidance Notes. Communication: Communications are open and effective. Healthy communication channels exist vertically and horizontally within the organisation. Managers and masters are prepared to listen as well as speak. Everyone has, and understands, all the information required for safe operations. Communication channels are monitored for their effectiveness. Empowerment: Individuals feel empowered to successfully fulfil their own safety responsibilities. The organisation provides clear delegation of, and accountability for, safety-related responsibilities. Each member of the workforce is provided with the authority and resources to allow success in his/her assigned roles. Each member of the workforce accepts and fulfils his/her individual safety responsibilities. Management expects and encourages the sharing of safety concerns by everyone in the organisation. Feedback: Management responses to safety issues and concerns are timely. Priority is placed on the timely communication of, and response to, outcomes of incident investigations, audits etc. to the workforce. Mismatches between practices and procedures (or standards) are resolved in a timely manner to prevent normalisation of deviance. The workforce is encouraged to raise safety concerns, which are resolved in a timely manner. Mutual Trust: Relationships are characterised by mutual trust. Members of the workforce trust managers to ‘do the right thing’ in support of safety, and are expected to shoulder their share of responsibility for performance and to report potential problems and concerns. Employees trust the motivations and behaviours of peers. There is confidence that a just system exists where honest errors can be reported without fear of reprisals. Chapter 4. Safety Management Initiatives Safety Management Initiatives in Shipping 35 the full report is needed or an executive summary is sufficient. Safety researchers, such as Perrow (1999), advise that decentralised business units, such as ships, are better able to manage a continual stream of information regarding small failures that prevent future small failures than assimilate information about, and thereby prevent, rarer more significant failures. In other words, preventing major incidents is dependent on a business unit’s ability to learn from the smaller failures, and this is dependent on the effectiveness of the organisation’s communication strategy. Thus, information regarding smaller incidents needs to be disseminated widely and the findings integrated into operational practice. Recall Previous Incidents: In order to enhance further an organisation’s ability to prevent a major incident, information about previous incidents needs to be integrated into the review process. Proponents of adding this stage suggest that, if teams can visualise future failure modes that have yet to occur prompted by the recalling of previous incidents, they increase the potential to avert more serious incidents (Bird & Germain, 1986). Corrective Actions: The final step in the process is to implement the lessons learnt and take corrective action. Critical to the success of this stage is the organisation’s ability to monitor progress on, and close out, corrective actions. Audits and inspections can be used to establish progress on corrective actions so the post-incident review process needs to be closely integrated with the planning and monitoring systems operated by the organisation. These steps in the post-incident review process are captured in Figure 4.3. Incidents Identification and Response Reporting Investigation Causal Structure Learnings Corrective Actions Inputs Incident Recall Share externally with other locations, businesses, and industry associations etc. Business System Continuous Improvement Cycle Figure 4.3 A Post-Incident Review Process, After Cooke (2003; p.20) Effectiveness and Limitations As post-incident reviews are a process, if any steps are missed out, the process will falter and learning from incidents will not occur. Similarly, if the amount of information generated by the process exceeds the organisation’s capacity to investigate and apply the lessons learnt, the post-incident review process will again falter. A key stage in the process, therefore, is to set the threshold at an appropriate level, bearing in mind moral and legal safety obligations, and to invest sufficient resources to carry out appropriate investigations. Many shipping operations strive for zero incidents, but if achieved this would yield zero opportunities to learn from incidents. The author of the process that has been reviewed above also discusses the paradox between the number of incidents and the opportunities for learning and suggests that what is critical is the severity of the consequences. Cooke advocates that the process of learning from incidents should focus on minimising the severity per incident and not necessarily minimising the number of incidents per se; in other words, organisations should strive for zero losses not zero incidents. Chapter 4. Safety Management Initiatives Safety Management Initiatives in Shipping 37 4.5 Safety Incentive Schemes Definition Safety incentive schemes are a form of behaviour modification technique where rewards are used to encourage compliance with safety practices, rules and procedures. The primary aim is to reduce accidents. As with other behaviour modification techniques, they rest on the premise that consequences drive behaviour (see Section 4.2 on Behavioural-Based Safety Management) and, as their name suggests, safety incentive schemes use positive rewards (consequences) to reinforce safe behaviour. These rewards may be in the form of financial incentives, or praise and feedback. According to researchers in the field (McAfee & Winn, 1989): “[The use of positive reward] removes the unwanted side-effects associated with discipline and the use of penalties; it increases the employee’s job satisfaction; it enhances the relationship between the supervisor and employees; it increases the probability of safe behaviour rather than reducing the probability of unsafe behaviour; [and] is more direct than punishment in its effects”. Fundamentals of Safety Incentive Schemes Safety incentive schemes employ incentives to encourage pro-safe behaviour and, when properly designed, obtain the approval of those for whom they are intended. They operate on the basis that a small carrot is better liked by employees than a big stick and the finding that carrots are generally more effective in changing behaviour than sticks (Wilde, 2011). According to the UK’s Health and Safety Executive, incentives and rewards can be used to: • Encourage employees to follow health and safety procedures • Reward those who achieve outstanding health and safety performance • Reward those who actively support a good culture on site • Encourage participation in safety initiatives such as surveys • Encourage, reward and reinforce specific safe behaviours. Types of Rewards Table 4.7 describes a number of monetary reward schemes that are employed in on-shore industries. These schemes have been identified by the HSE in their Leadership and Worker Involvement Toolkit series (Leadership and Worker Engagement Forum, n.d.). The list in the table is far from exhaustive. Other schemes include additional holidays, free fuel, lottery tickets, company shares, customised merchandise, certificates and public commendations. Chapter 4. Safety Management Initiatives 38 Safety Management Initiatives in Shipping Types of Rewards and IncentivesTarget or Scheme One-off prizesIndividuals or groups. Monthly gift vouchersA monthly scheme whereby those receiving reward vouchers for observed safe behaviours have their names entered into a prize draw to receive a cash prize or gift voucher. Moral incentiveThe organisation gives £1 to charity for each safe behaviour observed or for every person who attends a safety event. Safety raffleA monthly draw for all workers receiving a ticket for safe behaviour. Prizes can range in value from, say, £100 to a car. ‘Knock off early on Friday’Individuals or groups are permitted to leave work an hour earlier than usual. ‘There and then’Rewards given immediately and in front of peers for a single observed safe act, e.g. a voucher for a meal or a drink. Monthly awardsRecognition is accumulated over time and an award given to ‘safe person of the month’. Table 4.7 Types of Safety Incentives (after HSE, 2012) Effective Incentive Programmes In order for incentive schemes to achieve their intended effects, i.e. improve the probability of safe behaviour and reduce accidents, there are a number of requirements that need to be adhered to. The guidance presented here is a combination and summary of that from the UK’s HSE and from the International Labour Organization (ILO). Management of the Scheme: The initial success and long-term viability of incentive schemes depends on a number of factors: • Management’s commitment to the scheme • Perceived equity of the distribution of rewards • Fair and consistent application of the programme rules • Perceived attainability of the rewards • Time interval between behaviour and receipt of the reward. A reward scheme needs to be communicated fully so that everyone knows what it takes to achieve an award and what observers are rating. It needs to be kept alive by those responsible for the incentive programme through marketing of the scheme, and employees need to be informed regularly of the results. There is some debate about what should be rewarded, with the ILO suggesting the outcome should be rewarded, e.g. not having had an accident, rather than the behaviour, e.g. wearing safety glasses. The argument for incentivising the outcome rather than specific behaviours is that, when a specific behaviour is