Sofema Aviation Service www.sassofia.com looks at SMS reporting from the EASA perspective

What do we mean by Safety Occurrence Reporting?

We use the term Safety Occurrence to identify as a collective term which is used to embrace all events which have, or could have significance in the context of aviation safety.

Events identified may in fact range from minor events which are deemed to have a potential for an impact on safety through to incidents or events that should be reported to more serious events including serious incidents and accidents.

Building a Reporting Culture

The willingness to report, safety related exposures is a significant measure when we are considering the effectiveness of Safety Management System.

One of the biggest barriers to an effective Safety Management System (SMS) depends on the willingness of the employees to engage with the organisational system and for the managers to support such a program in a positive and tolerant way.

Without the willingness to engage with the Safety Management System (SMS) the level of data capture will lead to the creation of barriers.

Full engagement by the Management Team is an essential first step on the journey and without doubt. If we are going to maintain a healthy safety management systems (SMS) we require an open process of hazard reporting which allows us to understand the exposure and to reduce the operational risk.

How we are impact the various organisational barriers is in turn impacted by cultural and other behaviours which are often routed in mistrust.

Sofema Aviation Services www.sassofia.com looks at typical performance indicators within an Integrated Operation

Flight Operation

Ground Operations

Maintenance

The following list serves as an introduction to a range of indicators which may be employed within your organisation to support the development of Key Indicators and to facilitate the measurement of Safety Performance across the business.

Using Data derived from the Compliance Quality Audit Program to support the Performance Metrics of the Safety Management System

1/ Internal audits/compliance monitoring: all non-compliances

a) Total number of findings per audit planning cycle & trend

b) % of findings which have a safety significance

A Discussion Document by Steven Bentley - MD of Sofema Aviation Services

Do we agree the purpose of an Aviation SMS?

1/ According to ICAO

ICAO Doc9859 para 2.13.2 - ‘A hazard is generically defined by safety practitioners as a condition or an object with the potential to cause death, injuries to personnel, damage to equipment or structures, loss of material, or reduction of the ability to perform a prescribed function.’

ICAO Doc9859 para 2.14.2 - ‘Safety risk is the projected likelihood and severity of the consequence or outcome from an existing hazard or situation.’

There are many misconceptions and misunderstandings regarding Aviation Safety Management Systems (SMS) and Quality Management Systems (QMS).

The following is intended hopefully to clear up this misunderstanding:

QMS and SMS - Offers many common methods and techniques, but provides different outcomes an objectives:

Sufficient competent resources are critical to the success of both the CM system and the SMS. It is also important to realize that essentially the role of both QMS and SMS is to provide a service to the management team to understand both the non-conformities and risks which they face within the business areas.

We are very pleased to announce the availability of our latest training which provides for an opportunity to update regarding both the status and effectiveness of your organisational SMS.

Building on the successful release of several Aircraft Maintenance Planning and Production Planning Courses we are pleased to offer this opportunity to provide for a review and update of SMS best practice processes to be developed within your organisation.

Developed to be completed in one day Safety Management System Overview and Recurrent provides for a comprehensive review of the overall effectiveness of your SMS.

We have watched Safety Management Systems grow following an understanding that the reality today is that the major cause of accidents is related to human error which in some way is able to impact the overall process increasing the level of risk and exposure.

When we consider Dangerous Goods (DG) in aviation the primary concern is the Safety of Passengers, Crew plus the Aircraft as of course the actual Goods which are being transported.

If DG is mishandled in some way it can cause delays and disruption, it may even cause a serious and ultimately fatal accident with the potential loss of even of the aircraft and occupants.

What do we mean by DG?

Essentially we may consider Dangerous Goods are articles or substances capable of posing a risk to a person’s health, safety, property or the environment.

As well as Dangerous Goods which form part of the aircraft basic operational configuration and as such do not need to be declared, Dangerous Goods are also carried on-board the aircraft in passenger or crew carry-on baggage, as well as in the cargo holds as checked passenger baggage, or carried and declared as Dangerous Goods in cargo.

Hazards of Airplane Fuel - Tank Entry
 
To ensure effective maintenance within the Fuel Tank Systems there is a need to develop procedures associated with Fuel Tank Entry, Personnel Protection, Working within the Fuel Tank Environment and Fuel Tank Closure.

The separate elements to consider include fully understanding the potential hazards - Fire and explosion, toxic chemicals as well as oxygen deficiency.

Procedures for entry within the tank, ensuring the safety of the environment for the maintenance worker.

Preparations include electrically grounding the aircraft, defueling in accordance with maintenance manual procedures and deactivating all associated systems to ensure personnel safety.

Do we agree on what we mean we talk about the management of change in connection with our Safety Management System (SMS)?

Essential we are talking about changes within the business which may in some way increase our exposure to risk!

Unfortunately within the business many changes take place which are not considered for the impact that they may create related to increased risk, any lack of communication or in fact even perceived lack of communication (yes perception can lead to negative outcomes) may have negative connotations or worse!

Change Management is an area which deserves more attention than often it receives, the more visibility we provide and the more attention we give to the change then the more likely we will be to address the underlying issues.

What do we mean by developing a consistent approach?

Well, we want our approach to be system driven and not overly reliant on individuals. Means we want the outcomes to be as independent as possible from the people.

For this to happen a number of elements need to be in place:

a) Procedures

The procedures which describe the methodology employed need to be in sufficient detail to enable all the users to work with them in the same way. We are always going to have a significant degree of subjectivity in our approach to SMS but this does not preclude the development of effective procedures.

What is the goal of the Aviation Safety Management System - SMS?

Well quite simply it is to:

a) Identify hazards or exposures across every area and facet of the business (ideally considering also financial exposure)
b) Assess the risk in respect of each hazard and how it is currently perceived or how it may be perceived in the future to the organisation, department or person (This is an extremely subjective activity and requires a strong degree of competence)
c) To develop appropriate mitigations to deliver an improvement which will take the risk to the lowest level possible (ALARP) using organisational tools to test or measure proposed solutions so that they are cost effective

We “should” all agree that an effective aviation Safety Management System establishes clear safety roles and responsibilities throughout the organization.

Moreover it should also be understood that we must ensure that these safety roles and responsibilities are clearly documented, (Auditable) understood, (Measurable) and practiced throughout the organization (Visible and Evidence based).

Our goal should be for individuals to both understand their own responsibilities together with an appreciation of how their individual activities may impact the safety, performance and behaviour of our colleagues within the organization as a whole.
Each business area within the organization must assume both responsibility and accountability for safety of the key elements of personal safety and organisational safety and financial safety.

Best Practice Behaviour to support our SMS

All employees should have a clear understanding of their individual safety roles and responsibilities. (This information should also appear in each job description.)

Who is best placed to answer this question? In fact the starting point should be – "What do we want our SMS to do for us?"

We often talk about the management of change and here we do not need to look any further than the implementation of an SMS as our first challenge.

As either a perfect opportunity to develop and optimize the organisation or alternatively as an organizational burden which requires specific actions to ensure compliance.

So in reality this question should be answered by the Accountable Manager and the Management Team. In fact once we answer the question then other decisions become easier and we can start to develop the structure of the SMS.

Please note it is a significant step backwards to jump into SMS implementation without really appreciating what your real goals are. So assume we have decided that we see the SMS as a real business opportunity to develop and optimize the organization.What should we do next?

To consider the differences and the advantages of bringing together the elements associated with MEDA and the analytical capacity which is available within the SMS system.

Maintenance Error Management System (MEMS) which is typically represented by “Maintenance Error Decision Aid” (MEDA) as developed by Boeing is an effective way of analyzing events (initially MEDA was developed to facilitate the analysis of incidents and accidents – At the inception its use was employed where there was an adverse outcome; however it was subsequently extended and it is now typically found to be also be employed for the investigation of events.