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Engineers Australia Qld Division – Risk

Management Concepts

21 July 2014

Contents

• My own journey – some navigation aids and

axioms

• Downer Mining – current examples

• Effective Operational Risk Management

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SOME NAVIGATION AIDS

Google names or start with:

Charles Perrow, http://press.princeton.edu/titles/6596.html

Erik Hollnagel http://erikhollnagel.com/

Ralph Staceyhttp://en.wikipedia.org/wiki/Ralph_Douglas_Stacey

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Operational Risk Management must:

Dan Petersen’s axioms adapted

1. Force frontline leader action

2. Involve middle management

3. Have visible senior management support

4. Engage the workforce

5. Positively contribute to how work is done

6. Be flexible

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5

Far from Agreement

Close to Agreement

Far from Certainty Close to Certainty

Chaos

Ordinary Management

Social an

d Peo

ple Fixes

Technical Problem Solving

Middle Ground Extra-ordinary Management

Ralph Stacey Agreement and Certainty Matrix (Adapted)

Adapted from the Ralph Stacey Matrix –

Domain of Interest

Extraordinary Management

Ordinary Management

Safety Transformation - Ralph Stacey Matrix Perspective

Perrow and Hollnagel

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PRACTICE IN DOWNER MINING

About DEM – UG, Otraco, DBS, ReGen, Open Cut

Mar 13 Jun 13 Sep 14

Operational Steering Group - oversight

Ongoing Project Health Support and Promotion – four campaigns, climate surveys etc.

Occupational Physician pre employment medical oversight and Workers Compensation focus and ongoing active complex case management

Downer Group Zero Harm Framework and Assurance Processes

Intent and Requirements Standard framework established

Maintenance Excellence Project - Task Instruction documents

Refresh ZH audit/review

Downer Group – ZH Critical Risk Process

Ongoing Business Level Risk Management

Ongoing ZH Leadership course with clear operational integration and support and aligned with Supervisor Capability Framework

Downer Mining operational standards working group

Downer Mining FY15 Zero Harm (Health & Safety) Plan Overview Working – May 2014

Critical Risk Dialogue

Mental Health Management Awareness

DBS Mental Health Peer Support Pilots

Large Site Project Pilot

Critical Risk collate in ARM and STI

Business unit projects

Periodic Health Process - Pilots

Goal 2 Employee Resilience Supporting employees and living our values

Goal 3 Critical Risk Line of sight risk management

Goal 4 Fit for Purpose Systems Value adding framework and components

Jun 14 Mar 14 Dec 14

Downer Mining Values, Congruent Senior Manager messages and visible actions Goal 1 HSE Leadership Building commitment and capability

Leadership and Critical Risk - Project Role of Senior Managers

Resilient Employee – Commercialisation

Maintenance Excellence Project

Alignment & Standardisation - control centric critical risk management Alignment & Standardisation

Process ready to implement for all project types

Align IMS content and refresh PMP process

Goal 5 ZH Function Improving business support

Diagnostic Critical Risk Dialogue

Options

Next Steps Role definition

Integrate key ZH processes with how work is done – JHA, Take 5, Hazard ID etc.

Key questions for all employees

• What specifically in what you do can kill you or

others?

• What specific controls stop this happening?

• What is your role in maintaining the controls?

• What will you do if you think the controls are not

in place?

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What will be delivered • Consistent delivery of maintenance excellence (working the right way) improves how Downer Mining runs and you get better risk management

for free • Maintenance Supervision based on knowledge-based leadership where supervisors remain credible and develop relationships with their crews

and have the time to develop a shared vision of outcomes with maintainers • Each day competent and fit for duty maintenance staff are allocated their work by capable supervisors with

- ‘how to’ task information that is visual, fit for purpose, identifies hazards and controls to support and supplements their knowledge and knowhow

- The specific tools, equipment, components, and consumables required to complete the work safely and efficiently - The skills and experience to carry out a hazard review of the environment in which they are working - An understanding of change thresholds

• This combination of leadership, monitoring, support and well designed approaches delivers reliable and consistent control of maintenance critical risks

S F

Execute work

1. What other hazards do I have to

consider in the broader work

environment? What are the controls?

2. What are the hazards to others that I

am introducing as I carry out my

work? What are the controls?

3. How much can things change before I

stop and reset how I am approaching

this work?

Target State – Improving the reliability of critical risk management in maintenance

I understand and always apply integrated safety processes

Approve work Plan work Schedule work

Resource work Business Systems - Asset Management

Provide ‘fit for purpose’ Work Instructions that detail key hazards and controls at each task

step

Fit, competent, experienced and

motivated people who are ready to

work

Tools, Equipment Consumables & Components are

available

Provide ‘fit for purpose’ Work Instructions that detail key hazards and controls at each task

step

Fit, competent, experienced and motivated people who are ready to

work

Tools, Equipment Consumables & Components in

place

What other hazards do I have to consider in the broader work environment? What are the controls?

What are the hazards to others that I am introducing as I carry out my work? What are the controls?

How much can things change before I stop and reset how I am approaching this work?

The supervisor’s role is to coordinate the assembly of these parts and then monitor that they remain in place

The maintainer’s role is to ask the questions and get the work done on time and to specification using the resources and information provided

Establishing a standard Interface Model between supervisors and maintainers – Version 1

S

F

Loss of Control vehicle incident causing serious injury and/or

equipment loss

Fit for Purpose Vehicles Equipment suitable for application

Selection -Specify vehicle use requirements -Define minimum vehicle equipment e.g. CAS, chocks, lights, flags etc.

-Consider load weight and how it will be distributed

-Apply Plant vehicle minimum standards; Traction control, ABS etc.

Pre-use checks -Daily fit for purpose checks -Load planned and secured

Maintenance -Equipment faults ranked and corrected to schedule

-Does not operate with defined Category A faults

-Timely quality maintenance

Modification -Speed governors

Fit & Competent Drivers Knowledge, experience and capability to avoid loss of control

Competent -Licenses, training and assessment for vehicle

-Drives to conditions

Fit -Fatigue management -Journey planning -Fit for duty expectations including AOD screens

Culture -Clear operating expectations from supervisors and peers

-Productive safe behaviours are recognised and rewarded, unsafe behaviours are corrected

Operating Conditions & Standards Reducing demands on driver Roads and Ramps -Haul road standards -Controlled application of water -Routine pit inspections -Parking area standards; spoon drains -LV HV separation -Intersection design Operating standards -Pre-start briefing covers driving conditions

-Positive communications re hazards

Road Design -Physical barriers: berms windrows

-Run off ramps

Occupant Protection

OEM provided -ANCAP rating for LV -Seat belts -Air bags -Cargo barriers -Position of ancillary equipment e.g. Radios

After Market -ROPS for special purpose vehicles

Emergency Response Local emergency response

-Vehicle first aid kit -Fire extinguisher

Site emergency response Community emergency response

Insurance Alternative vehicles

Critical Risk Barrier Map - Vehicle Loss of Control (LOC) Resulting in Serious Injury and/or Significant Equipment Loss

Notes for Use:

1. Identify current controls/barriers 2. Consider the practicality of alternative and/or additional barriers 3. Assess the adequacy and reliability of the selected barrier 4. Detail the inputs necessary to maintain and/or improve barrier

adequacy and reliability 5. Ensure that employees understand their role in maintaining barrier

reliability 6. Continue to test and check barriers that are people dependent

Barriers to prevent LOC

Barriers that mitigate LOC

Monitor Ensuring people dependent barriers remain reliable Frequent -Supervision performance monitoring

-Check that pre-start equipment issues are closed out

-GPS tracking (speed and position) -CAS records Periodic -Speed checks -Assurance; competency and licensing

-Hazard and Incident reporting and investigation

Post incident

Effective Operational Risk Management

1. Effective risk management is a contact sport - a

requirement not an invitation

2. Beware of compliance façade and gaming

3. Risk assessment is not risk management

4. Get the thinking off the bookshelf

5. Don’t confuse task level hazard and control

6. Understand the bigger system (socio-technical)

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