SMS Implications for Education Jim Dow Chief, Flight Training & Examinations Transport Canada Presentation to National Training Aircraft Symposium March 2009

I hear and I forget. I see and I remember. I do and I understand. -Confucius

System means a group of interdependent processes and people working together to achieve a defined result. A system comprises policies, processes and procedures.

Safety Culture Learning Culture People are encouraged to develop and apply their own skills and knowledge to enhance organizational safety. Staff are updated on safety issues by management. Safety reports are fed back to staff so that everyone learns the lessons. Just Culture Atmosphere of trust where reporting is encouraged and where a line is drawn between acceptable and unacceptable behaviours. Informed Culture People understand the hazards and risks involved in their own operation. Staff work continuously to identify and overcome threats to safety. Reporting Culture People are encouraged to voice safety concerns. When safety concerns are reported they are analyzed and appropriate action is taken

RoleTraditional ApproachSMS Approach InspectorInspectors are regulatory compliance auditors. Inspectors are system evaluators. CompanyThe company responds to regulatory requirements. The company proactively manages risks. Transport Canada TC inspects aircraft, records, and personnel directly. TC assesses whether companies have effective processes to ensure safety. A System Change

OperatorIn Force Airlines/AMO2005 ATS Operations2008 Airports (Group 1)2008 Airports (Group 2)2009 Aerial Work, Air Taxi, Commuter, Flight Training, AMO 2009 Heliports, Water Airports, Approved Manufacturers, Aircraft Certification 2010 Implementation

Implementation Phases Initial Review 1 Year Follow-up 2 Year Follow-up 3 Year Follow-up Accountable Executive Gap Analysis Implementation plan and responsible person SMS Plan, Policies, and Procedures Reactive Reporting System Proactive hazard identification Training Quality Assurance Emergency Preparedness

ComponentElement Safety Management Plan Safety Policy Non-Punitive Safety Reporting Policy Roles, Responsibilities & Employee Involvement Communication Safety Planning, Objectives and Goals Performance Measurement Management Review SMS Components

ComponentElement Documentation Management Identification and Maintenance of Applicable Regulations SMS Documentation Records Management Safety Oversight Reactive Processes Proactive Processes Investigation and Analysis Risk Management SMS Components

ComponentElement Training Training, Awareness and Competence Quality Assurance Operational Quality Assurance Emergency Preparedness Emergency Preparedness and Response SMS Components

ComponentKnowledge Initial Training All Staff Principles of safety management Corporate safety philosophy, safety policies, safety standards, etc. Importance of complying with safety policy/procedures Corporate safety record Corporate safety goals/objectives Corporate safety management programs – reporting systems, LOSA, etc. Ongoing internal assessment of safety performance SMS - ICAO

ComponentKnowledge Initial Training All Staff Reporting accidents, incidents, perceived hazards Lines of communication for safety matters Dissemination of safety information Safety awards Safety audits Safety promotion SMS - ICAO

ComponentKnowledge All Operational Personnel Procedures for reporting accidents/incidents Unique hazards facing operational personnel Procedures for hazard reporting Specific safety initiatives (e.g. FOQA) Safety committee Seasonal safety hazards/procedures Emergency procedures SMS - ICAO

ComponentKnowledge Evolution of safety management Aviation accident history Quality control Quality assurance Quality system Safety management system Operational vs system quality assurance Safety and security System complexity SMS Knowledge

ComponentKnowledge Organizational Culture and Human Factors in Aviation Reason’s Model SHEL Model Rasmussen’s Ladder Cause and effect Bias SMS Knowledge

ComponentKnowledge Risk Management Hazard definition and identification Risk assessment process Proactive vs reactive processes Threat and error management Incident/Accident Investigation Techniques Process SMS Knowledge

ComponentKnowledge Data Collection and Processing Safety reporting systems Design and categorization Manual vs electronic databases Evaluation and Analysis Root cause Trend Fault tree Maintenance Error Decision Aid (MEDA) Procedural Event Analysis Tool (PEAT) SMS Knowledge

ComponentKnowledge Safety Program Development and Operation Management involvement Employee involvement Process vs procedure Safety performance measurement Documentation Regulatory requirements System evaluation SMS Knowledge

ComponentKnowledge Emergency Planning and Response Theory – containment and mitigation Planning Procedures SMS Knowledge

SMS Information