OPRATIONAL RISK MANAGEMENT

System Safety

Risk Management

SYSTEM SAFETY

Definitions:System Safety: The application of engineering and management principles, criteria, and techniques to optimize all aspects of safety within the constraints or operational effectiveness, time, and cost throughout all phases of the system life cycle.Fail Safe: A design feature that ensures that the system remains safe or in the event of a failure will cause the system to revert to a state which will not cause a mishap.Hazard Probability: The aggregate probability of occurrence of the individual events that create a specific hazard.Hazard Severity: An assessment of the consequences of the worst credible mishap that could be caused by a specific hazard.

Management: the act, manner, or practice of managing, supervising, or controlling.Hazard: existing or potential condition that can result in or contribute to a mishap.Fault: a weakness or defect; mistake or errorFailure: inability of a system, subsystem, component, or part to perform its required function within specified limits.Emergency: unintended circumstance bearing clear and present danger to personnel or property which required immediate response.System: a group of interrelated, interacting, or interdependent constituents forming a complex whole; a functionally related group of elements.Risk: as applies to safety is the exposure to the chance of injury or loss.

SYSTEM SAFETY

SYSTEM SAFETY

System Safety made a significant contribution to the improvement of all types of aviation safety through engineering design processes and operational safety processes.

Differences between basic system safety steps (methodology) and that of Operational Risk Management steps are only in the degree of generality. See below:System Safety Process: Define ObjectivesSystem DescriptionHazard IdentificationHazard AnalysisRisk EvaluationHazard Controls

LIFE CYCLE SAFETY

The portions of the life cycle of an air transport category aircraft that we will be concerned with are:Concept and Definition phasesDetailed design, fabrication and developmentDeployment and OperationsModifications

Failure Modes and Effects Analyses: FMEA/FMECA is performed on system components. There are several things that such analyses provide:Failure modes for the part / component.History of those failure modes expressed in failure rates , usually a function of time, failure mode frequencies, and severity of the failure or what impact does it have on the functioning of the item.Cause of the failureAffect upon the next higher level of the system or subsystem.Criticality which is simply the product of the failure rate, failure mode frequency, and the severity expressed as a fraction.

THE SYSTEM SAFETY HIERARCHY

System Safety Program:•System Safety Program Plan

•System Safety Tasks•System Safety Engineering

•Hazard Analyses•Design Requirements

•Hazard Risk Assessments•Probability (Reliability Analyses)•Severity (Quantitative Analyses)•Risk indices

•Safety Reporting•Contract Documents•Safety Recommendations

(continued)

THE SYSTEM SAFETY HIERARCHY

•System Safety Applications•Preliminary Analyses•Design Changes•Operational Analyses•Life Cycle Support

•Verification of Controls•Risk Acceptance•Documentation•Reviews

OVERVIEW OF ORMOperational Risk Management Processes

•Identify potential hazards•Access the risks•Analyze risk control measures•Make control decisions•Implement risk controls•Supervise and review

OPERATIONAL RISK MANAGEMENT

OPERATIONAL RISK MANAGEMENT

Rules for making risk decisions:Accept no unnecessary riskMake risk decisions at the appropriate levelBenefits of taking risk must outweigh the costsIntegrate ORM into task planning and execution

OPERATIONAL RISK MANAGEMENTMore Risk Definitions:

Identified Risk: Risk that has been determined through various tools.

Acceptable Risk: Identified risk that is allowed to persist without further controls.

Unacceptable Risk: The risk than cannot be tolerated.

Unidentified Risk: Risk that has not been determined.

Residual Risk: Sum of acceptable and unidentified risk.

RISK ANALYSIS PROCESSES

RISK = (f) of PROBABILITY & SEVERITY

Seminole Fuel System Schematic

AVIATION SAFETY

Operational Aviation Safety:1.Airworthiness

• Flight Safety• Ground Safety• Engineering• Quality Assurance• System Safety

2.Medical Factors3.Operations and Maintenance

AVIATION SAFETY

Aviation Safety Continued

Aircraft Mishap Prevention:1.Safety Program Management

• Risk Management• Safety Data• Material Factors

2.Supervision3.Mishap Investigation

Human Factors:1.Human Factors Design2.Human Psychology3.Human Physiology

SYSTEM SAFETY HIERARCHY

System Safety Program:•System Safety Program Plan

•System Safety Tasks•System Safety Engineering

•Hazard Analyses•Design Requirements

•Hazard Risk Assessments•Probability (reliability analyses)•Severity (quantitative analyses)•Risk indices

•Safety Reporting•Contract Documents•Safety Recommendations

•System Safety Applications•Preliminary Analyses•Design Changes•Operational Analyses•Life Cycle Support

SYSTEM SAFETY HIERARCHY

FUTURE TRENDS OF AVIATION SAFETY

1.Swing more towards automation in operations, maintenance, etc.

• How do you determine the risk of upgrades to computers and the communication systems?

• Where doe the pilot fit into the loop?

• Where does the safety manager fit into the loop?

2. ORM begins to spend more time on reducing pilot error which drives more simulation and automation.

3.System Safety has become passé’ and is being superseded by Software Safety Analyses.

4. Human Factors have reached the point where only major design changes in aircraft will accommodate the safest man-machine interface and that leads back to automation changes.

FUTURE TRENDS OF AVIATION SAFETY

5.Life Cycle of the aircraft get extended; esp. in times of tight economics.

6. Systems approaches to all safety are the trend.

FUTURE TRENDS OF AVIATION SAFETY

NASA Dryden Research Aircraft Photo CollectionNASA Dryden X-43A Photo CollectionNASA Dryden X-43A Photo Collection

5.Life Cycle of the aircraft get extended; esp. in times of tight economics.

6. Systems approaches to all safety are the trend.

FUTURE TRENDS OF AVIATION SAFETY

NASA Dryden Research Aircraft Photo CollectionNASA Dryden X-43A Photo Collection

Eclipse EM-0008-04: Eclipse QF-106 tethered flight #4

Eclipse EC97-44357-13: Eclipse project QF-106 and C-141A climbs out under tow on first tethered flight December 20, 1997

NASA Dryden Research Aircraft Photo Collection