50% Reduction: A Review of the Basics, The

Mobility Forum, Sep/Oct 2004 by Meeks, Bayne

Staring into the cockpit ofthat F-15 at the Air Force Crash Lab at Kirtland AFB, it really hit me as I reflected on the fact that someone had died right there. The bottom line for us as safety professionals is to save lives. But it is not just the responsibility of those that attend the schools or work in safety positions; it lies with all of us involved in aviation. In the safety arena, much emphasis is given to "breaking the chain of events" and finding the root cause of mishaps in order to prevent future ones. This chain, however, sometimes evolves more into a tangled web than just a one dimensional path to follow. This potential complexity demonstrates the need for the depth and breadth of focus required to cultivate and sustain an effective safety culture. Pidgeon and O'Leary (1994) define safety culture as "the set of beliefs, norms, attitudes, roles, and social and technical practices within an organization which are concerned with minimizing the exposure of individuals both within and outside an organization to conditions considered to be dangerous." Well that sounds just great you say, but we're at war here!

We no doubt signed up for a demanding job, one in which you may very well make the ultimate sacrifice for your country, but that very fact should energize you to do everything in your power when you are hacking the mission to keep that from happening. As members of the USAF, we are part of an amazingly powerful team and we all have a responsibility to preserve and continue to strengthen this team. In February of this year, CSAF Gen Jumper put forth the challenge of zero mishaps for the Air Force as part of secretary Rumsfeld's 50% mishap reduction goal. In the wake of the wars in Iraq and Afghanistan, sustainment efforts in both of those theaters, and the continuing global war on terror, I believe that as a part of our efforts to reduce mishaps, we need to re-examine the basics. We have to foster a culture from the very top down to the foundation of this organization if we want to make this goal of zero mishaps a reality. It is not going to be done with briefings, watching videos, or bulletin boards. It has to be done with actions that build trust and gain respect.

The challenge for us is obvious. Flying airplanes is inherently dangerous to begin with and now we regularly do it while in harm's way in every corner of the world. So how do we get the mission done and do it in the safest manner possible? We establish a fundamental approach that can be adapted for any circumstances. It requires a concerted effort from everyone involved in every aspect of the force; from the senior leadership, throughout the command staff, to the wings, and fundamentally to each and every one of us wearing the blue suit.

In our line of work there are many risks. Through operational risk management (ORM) at every level from the top down, we can achieve a cascading effect that will result in overall safer and more effective mission accomplishment. But, ORM is not something to be accomplished by your safety office. You are the expert in your area and the idea is for you to use your expertise and knowledge to identify and mitigate the risks associated with your piece of the puzzle. For example, if you identify a risk that affects another part of the team, let them know about it. As an aircraft commander filling out the ORM worksheet before you go fly, you are highlighting challenges and obstacles that may affect safe mission accomplishment and developing a game plan as a crew to overcome those issues and mitigate the risks. It is not about just getting that number into the low category.

Remember, the human is a factor in everything we do. Every link of the chain or strand of the web, as the case may be, involves some form of human interaction. Communication is the key. Recently I read about a concept that I think ties everything together and provides a good blueprint for examining and building on the basics of organizational safety and success.

In their text "Handbook of Aviation Human Factors," Garland, Wise, and Hopkin discuss the concept of building a high-integrity human envelope. The next paragraphs are a summary of their key points and some of my own observations as well.

The human envelope develops, maintains, interfaces, and evaluates the functioning of the social and technical aspects of the system. Compromises to its strength and integrity uncover the system's weaknesses and make it vulnerable; therefore, an organization that nurtures this envelope will be strong, and one that weakens it is asking for trouble. Getting the right equipment, operating the equipment, growing a highintegrity culture, maintaining human assets, managing the interfaces, and evaluation and learning are activities that provide the high integrity envelope.

Getting the right equipment. The organization must search out the best equipment (within the constraints of cost) to match mission requirements, test it carefully, and endeavor to use it with close attention to its strengths and weaknesses. Just as important as the right equipment is the intellectual toolkit that goes along with it. Obviously we have plenty of manuals and regulations to guide us along, but as we all know, there is a large body of implied knowledge regarding the finer points of operation. We as operators, maintainers, and managers must take charge of compiling this vital information and see that it is passed along. Take responsibility to see that vital information makes it into the manuals and regulations, and be vigilant about transferring this composite knowledge when changing jobs, PCSing, separating, or retiring. A constant dialogue is required between manufacturers, operators, and regulators, not a single transmission. Enhancements are continuously being made to improve the safety and reliability of our equipment. The challenge is to think through these actions fully so that we avoid the danger of actually degrading safety.