1. IFATCA's Perspective on TEM and NOSS
Dale Wright
IFATCA Executive Board

2. IFATCA's Involvement IFATCA participated in: 1st ICAO TEM Workshop
El Salvador, San Salvador, April 2002
3rd ICAO LOSA Week
Dubai, UAE, October 2002
3rd ICAO/IATA TEM/LOSA Conference
Kuala Lumpur, Malaysia, September 2005
1st ICAO Symposium on TEM and NOSS
Luxembourg, November 2005
This is simply a listing of events related to TEM, NOSS and LOSA (the data collection tool for the airline environment) where IFATCA participated.
The next slide shows our position after attending the first two events.

3. IFATCA's Position in 2002 TEM philosophy can be applied to ATC
Normal Operations Monitoring can be applied in ATC, but:
LOSA is not a suitable tool for ATC
A new tool needs to be developed
Normal Operations Monitoring is only useful in organisations with a mature Safety Management System

4. Developments Since 2002
2003: Informal working group discussing a tool called Normal Operations Safety Survey – NOSS (i.e. LOSA for ATC)
2004: ICAO establishes the NOSS Study Group (NOSSSG)
Members: Airservices Australia, Airways Corporation New Zealand, NavCanada, ATC The Netherlands, DFS Germany, Eurocontrol, UK CAA, FAA, IFATCA
University of Texas as scientific advisor
IFATCA participated in the informal working group (2003) and is a member of the ICAO NOSS Study Group (2004).
The next slide will show the Policy that was adopted in Melbourne 2005.

5. IFATCA Policy (2005)
Monitoring Safety in Normal Operations must be seen as an integral element of a Safety Management System.
A Safety tool such as NOSS, shall meet the following conditions:
Joint management/controller sponsorship;
Voluntary participation;
Trained observers;
set targets of safety enhancements;
de-identified, confidential, and non-disciplinary data collection;
adequate feedback of the results to the controller
(Melbourne 05.C.5)
Present the Policy as a whole, and after that use the red box to highlight the SMS part. The next few slides are about SMS. This slide will be revisited after the SMS part.
Notice that the 2nd part of the Policy is about generic safety data collection tools (for normal operations) and not specifically about NOSS. However, NOSS as developed by ICAO has 10 operating characteristics that include the 6 points mentioned in the IFATCA Policy, so NOSS is "approved by IFATCA".
(At this point in the Symposium programme the 10 NOSS characteristics will not yet have been presented to the audience. They will probably come up on Day Two. The NOSS characteristics are very similar to the 10 characteristics for LOSA.)

6. Normal Operations Safety Survey
Automated Safety Data Extraction
Proficiency Checking
Incident Reporting & Investigation
This slide shows sources of safety data as "building blocks" in a Safety Management System. (The bottom one strictly speaking is not really a source for safety data, but I believe it is literally the foundation of all other elements, hence its inclusion in this picture.)
The elements of the tower and the associated arrow & text will appear after each mouse-click. This gives you time to introduce or discuss the elements.
Each element provides a more complete picture, but NOSS is the "crown" (and provides the best view, in combination with the other elements).
Also noteworthy: ProfChecking and Auto Data Extraction make the tower higher, but don't provide a platform for better viewing!!!
Accident Investigation
Safety Related Working Conditions

7. Normal Operations Safety Survey
This whole slide will build after one single mouse-click. The point is that if you add NOSS to an incomplete SMS (or if you like: to just a few existing SMS elements) you may think your view improves – picture on the left side – , but you're a long way off from having a complete view – picture on the right side.
Proficiency Checking
Accident Investigation

8. Safety Change Process
Explain the cycle, starting on the top right with "ATC Operations" and continuing clockwise. I've made it a generic cycle, with Feedback coming from multiple sources including NOSS.
Main point: if an organisation has no mechanism to Implement Changes that result from safety investigations, there's no point in doing these investigations. This point is made explicitly for NOSS on the next slide.

9. The TEM framework is a way of thinking; almost a safety philosophy
Message For ATSPs
If you don't have a sound Safety Change Process, don't bother thinking about having a NOSS
The TEM framework can be introduced in the training and operations of any ATSP
Main points are in the textbox at the bottom of the slide. You can introduce TEM without NOSS, but there can be no NOSS without TEM. (This latter point should perhaps be clarified: for a NOSS you need observers who understand TEM; it is not necessary however that the whole organisation is familiar with TEM when doing a NOSS. Of course it makes life a lot easier when the whole organisation is familiar with TEM, for everyone concerned with the NOSS will understand what it is about.)
The TEM framework is a way of thinking; almost a safety philosophy
NOSS is a tool for safety data collection in normal operations, based on the TEM framework

10. IFATCA Policy (2005)
Monitoring Safety in Normal Operations must be seen as an integral element of a Safety Management System.
A Safety tool such as NOSS, shall meet the following conditions:
Joint management/controller sponsorship;
Voluntary participation;
Trained observers;
set targets of safety enhancements;
de-identified, confidential, and non-disciplinary data collection;
adequate feedback of the results to the controller
(Melbourne 05.C.5)
The Policy slide revisited. This time a red box is used to highlight one of the conditions, i.e. about the protection of the collected data. The next slides are about this subject.

11. Protection of Sources of Safety Data
IFATCA working paper for 11th ICAO Air Navigation Conference (2003): "A just culture, free from the threat of punishment is needed to ensure comprehensive and systematic safety occurrence reporting".
At the 11th ICAO Air Navigation Conference (2003), IFATCA submitted a working paper entitled "The Need for a Just Culture in Aviation Safety Management" (WP 92). The summary of that working paper reads as follows:
In the initial stages of development of the ICAO air traffic management operational concept, the concept panel was unanimous in its statement that safety must continue to be the highest priority in the planning and implementation of the future ATM system. To be successful, the industry must re-think its methods of doing business and move beyond a blame culture that singles out individuals and criminalizes error(s). With a cloud of legal liability hanging over system operators, progress in the quest for true system safety is in jeopardy. Accidents and incidents are not caused by individuals, but by many contributing factors. Focussing blame on system components (operators), is not the correct way to improving aviation safety, and is in fact, counter-productive as it stifles the reporting process. A just culture, free from the threat of punishment is needed to ensure comprehensive and systematic safety occurrence reporting.
In the Final Report of ANC/11 is recorded that the discussion on this subject resulted in the following recommendation:
Recommendation 2/4 — The protection of sources of safety information
That ICAO develop guidelines which will provide support to States in adopting adequate measures of national law, for the purpose of protecting the sources and free flow of safety information, while taking into account the public interest in the proper administration of justice.

12. Protection of Sources of Safety Data
Resolution from ICAO Assembly (2004): "..to develop appropriate legal guidance that will assist States to enact national laws and regulations to effectively protect information from safety data collection systems, both mandatory and voluntary, while allowing for the proper administration of justice in the State..".
Within the ICAO mechanism an Air Navigation Conference as held in 2003 could be described as a meeting at the highest operational level in the organisation. At the political level its counterpart is the ICAO Assembly, of which the latest meeting took place between 28 September and 8 October 2004.
In this meeting of the Assembly a Resolution was adopted that will lead to the development of legal guidance to assist all ICAO member states in enacting legislation to effectively protect information from safety-data-collection systems, both mandatory and voluntary, while allowing for the proper administration of justice.

13. IFATCA Position
Investigation of safety occurrences should be the first priority – not criminal prosecution
Safety data collected under any programme must remain privileged information
We, as a Federation have been for some time advocating the necessity for changes in the collection and dissemination of safety-related materials, and have lobbied other international organizations to join us in furthering this cause. We are very pleased to see the Flight Safety Foundation (FSF) shares our position. The Foundation first proposed in 2003 that appropriate principles for protecting critical safety data be incorporated into guidance for member states of ICAO.
The FSF position is not unlike our own; safety occurrence investigation - not criminal prosecution - should be the first priority, and safety data collected under voluntary programs or mandatory programs should remain privileged information … the occurrence investigation must be completed properly and probable cause(s) determined so that steps can be taken to ensure that similar occurrences can be prevented. When it comes to improving safety, this is far more effective than meting out punishment.
>>>SEE ALSO NEXT SLIDE

14. IFATCA Position
Occurrence investigations must be completed properly and probable cause(s) determined so that steps can be taken to ensure that similar occurrences can be prevented
In order to improve aviation safety there must be a free flow of safety-related information

15. Conclusion
IFATCA supports the development of NOSS as a tool for collecting safety data during normal ATC operations.
Straightforward.