Improving Your Business
Through Human Factors
3 February 2015
Welcome
Dr Ann Mills
Professional Head of Human Factors
Reflecting back
3
Industry Day
03 February 2016
Good stuff!
4
Industry Day
03 February 2016
An oldie but a goodie
5
Industry Day
03 February 2016
The future and beyond
• OPE TSI
Member States must set up an implementation plan for the requirements in
the TSI. This plan must take into account:
(a) the specific human factors issues associated with operating any given
line;
• Recast of the Railway Safety Directive
Article 9 The safety management system ……. There shall be a clear
commitment to consistently apply human factors knowledge and methods.
• Updates to the CSM Conformity Assessment and Supervision
6
Industry Day
03 February 2016
Time
Item
Presenter
10:00-10:15
Welcome
Ann Mills
10:15-11:00
Agenda
•
Glen Lyons
11:00-11:15
Break
11:15-12:30
•
•
•
Travelling as a passenger – a gift of time or a burden
Designing passenger information for dwell time to support
Thameslink high capacity infrastructure.
Tackling the rail worker accident plateau: applying a
psychological approach
ATW Culture change programme
12:30-12:45
Quick Fire poster session
12:45-13:30
Lunch
13:20-14:45
•
•
•
Development of a part task training tool
Bowtie diagrams: A user friendly risk communication tool
Importance of identifying and including representative
users throughout design
14:45-15:00
Break
15:00-15:50
•
•
15:50-16:00
Industry Day
A Cow with a pantograph: a review of driver signaller
communication for EU interoperability
The NTS conundrum: can you give people better NT skills?
Closing remarks
03 February 2016
Kate Moncrieff
Jim Morgan
Ian Jonah & Lisette
Bartlett
Ian Rowe
Claire Turner
Suzanne Heape
Bev Norris
Emma Lowe
Travelling as a Passenger
– a gift of time or a
burden
Glenn Lyons
University of West England
8
RSSB Industry Day, 3 February 2016, London
Travelling as a rail passenger –
a gift of time or a burden?
Professor Glenn Lyons
Centre for Transport & Society
UWE Bristol
Audience participation
Information
Mode Time use  Experience adjectives
Physical  Cognitive  Affective efforts
Mobile technologies
Your journey to London  Your commute
Travel time in context
6% of our waking day is spent travelling
4 million waking person years per year in UK
Conventional wisdom
“Time spent travelling during the working
day is a cost to the employer’s business. It is
assumed that savings in travel time convert
non-productive time to productive use”
15
I've heard that that the business case is
based on the idea that all the time
passengers spend on trains is wasted.
Isn't that stupid?
Challenging Convention
Frequency distributions of ‘productivity’
Travel time realities for rail
What if everyone’s in the office?
http://blogs.telegraph.co.uk/news/files/2014/09/tube-threat.jpg
Familiar sights
on board
22
Using time or killing time?
Travel time meanings
The meaning of travel time
 A means to an end – derived demand
– But the means can have value of its own
 A gift to others; a gift to oneself:
– Transition time – moving between life roles
– Time out / for – backstage or me time
 Clock time versus experienced time
– Stretched or compressed
 Crafting travel time
– Provider and traveller
– Privatising public space
Taking a closer look
“going up [on the train] was good because I
was going for a meeting about the work
magazine, I’m on the committee so it actually
gave me 2 hours to read the magazine the
latest edition so I could actually be ready for the
meeting because I’ve always been too busy at
work to find two hours to sit and read a
magazine.”
“on the train you are isolated from
other distractions, it’s a good place to
think or work. Since I do a lot of
creative writing for my role – playing
hobby, essentially I’m writing a stage
play, I really need time to just ‘be’ and
let me thoughts wander. The train is
great for this.”
Boiling down travel time uses
*
*
*
Car
(driver)
Train
Thinking


Writing/typing


Talking


Listening


Reading/watching


Sleeping/resting


Exercising


Eating/drinking
?

Effort
?
?
Time uses where the single occupant car cannot compete (yet)
Effort
Cognitive effort = 0 Affective effort = 0 Journey time use experience = high
Examining a Decade of Change:
2004-2014
2004-2014
 Franchised rail passenger journeys
up 52% from 271 million to 412 million
 Car trips/person+
down 9% from 649 to 590
 Households with internet access
up 71% from 49%* to 84%
 Adults (16+) owning a smartphone*
from N/A in 2004 to 61% in 2014
 Adults using internet on mobile phone in last 3 months
from 24% in 2010 to 58% in 2014
*UK +England
National Rail Passenger Survey
 how passengers spent their time on the train in question and also
the activity they spent most time on
 how worthwhile their time use had been
 what items they had with them on the train and which they used
 the extent to which they had planned in advance how to spend
their time on the train
 whether use of their travel time had been a factor in their choice
to travel by train
 to what extent ICTs had made the time spent on the train better
Autumn NRPS Survey waves and sample sizes
2004 – 25,596 2010 – 27,556 2014 – 27,812
% of all passengers spending any time…
Mobile internet
decline or substitution?
Low tech decline
less and less bored
Journey purpose ‘most likely to’
Commuters
Leisure
travellers
• work/study
• text/phone (work)
check emails
• eat/drink
• sleep/snooze
• read for leisure
• listen to
music/radio/
podcast
• watch a film/video
• browse the
internet
• play games
• be bored
• access social
networking sites
• text/phone
(personal)
• talk to other
passengers
• window
gaze/people watch
• care for someone
travelling with
them
‘industrious’?
‘monotonous’?
‘adventurous’?
‘any’ time – all waves (also for ‘most’ time except italics)
Business
travellers
Stability of dominant activities
Top 3 activities ‘most’ time spend on across all three waves
average % of passengers by purpose across waves
working/studying
reading for leisure
window gazing/people watching
talking to other passengers
Business
Leisure
Commuters Travellers Travellers
14
33
43
26
32
12
13
31
10
Over 10 year period, working/studying and reading for leisure
showing some decline for commuters and business travellers
(commensurate with ‘mobile internet’ activities growth)
Artefacts - % passengers having to hand
The rise and fall of superseded
technology
The rise of digital
technology
The fall of paper-based
technology
How worthwhile is travel time?
a mixed bag
saturation?
slowing decline?
Worthwhile time use and level of service
 Train rating in terms of sufficient room for all passengers to
sit/stand – ‘very good’ to ‘very poor’
 Satisfaction with journey – ‘very satisfied’ to ‘very dissatisfied’
 Rank order for both seating and for satisfaction:
Rank Wave Purpose
1.
2010 Leisure
2.
2014 Business
3.
2004 Commute
 Statistical association at respondent level between
seating/satisfaction and how worthwhile time use is considered to
be
Mode choice and time use (2014)
40% of passengers whose
time use was ‘very
worthwhile’ had
considered it a main reason
or important factor
16% of passengers whose
time use was ‘wasted’
had considered it a main
reason or important
factor
To what extent had you planned in advance how
you would spend the time on this train? (2014)
Journey
Purpose
Commuting
Business
Leisure
A lot
10
15
8
A little
20
39
27
Very little as I
always use my
journey time the
same way
46
22
25
Positive association between advance planning
and worthwhile use of travel time
Not at all
23
24
40
To what extent did any electronic devices you
had with you today make the time you
spent on this train better?
‘A lot’
Journey purpose
Commuters
Business travellers
Leisure travellers
2004
23
26
18
2014
37
41
19
Successive
generations
progress
could
improve
Marketing of
rail travel
The transition
from paper to
digital
could
reduce
The advance
planning
of time use
Rail industry
investment in
capacity
could
reduce
positively
influences
reduces
increases
The relative
appeal of rail
travel
Crowding
compromises
affects
increases
can increase
Consumer
investment in
ICTs
How
worthwhile
travel time is
reduces
More
exposure to
rail travel
limits
Successive
generations
progress
could
improve
Marketing of
rail travel
The transition
from paper to
digital
could
reduce
The advance
planning
of time use
Rail industry
investment in
capacity
could
reduce
positively
influences
reduces
increases
The relative
appeal of rail
travel
Crowding
compromises
affects
increases
can increase
Consumer
investment in
ICTs
How
worthwhile
travel time is
reduces
More
exposure to
rail travel
limits
Successive
generations
progress
could
improve
Marketing of
rail travel
The transition
from paper to
digital
could
reduce
The advance
planning
of time use
Rail industry
investment in
capacity
could
reduce
positively
influences
reduces
increases
The relative
appeal of rail
travel
Crowding
compromises
affects
increases
can increase
Consumer
investment in
ICTs
How
worthwhile
travel time is
reduces
More
exposure to
rail travel
limits
Successive
generations
progress
could
improve
Marketing of
rail travel
The transition
from paper to
digital
could
reduce
The advance
planning
of time use
Rail industry
investment in
capacity
could
reduce
positively
influences
reduces
increases
The relative
appeal of rail
travel
Crowding
compromises
affects
increases
can increase
Consumer
investment in
ICTs
How
worthwhile
travel time is
reduces
More
exposure to
rail travel
limits
Successive
generations
progress
could
improve
Marketing of
rail travel
The transition
from paper to
digital
could
reduce
The advance
planning
of time use
Rail industry
investment in
capacity
could
reduce
positively
influences
reduces
increases
The relative
appeal of rail
travel
Crowding
compromises
affects
increases
can increase
Consumer
investment in
ICTs
How
worthwhile
travel time is
reduces
More
exposure to
rail travel
limits
Concluding observations
 The appeal of rail travel seems linked to travel time use
which is ‘in the hands of’ passengers, aided by their
consumption of mobile technologies
 The rail industry benefits from this with a possibility that
it is countering the adverse effects on travel experience
brought about by crowding
 Greater rail capacity could be complementary to
achievement of worthwhile travel time use, sustaining
and extending the renaissance in rail in Great Britain
Thank you
Glenn.Lyons@uwe.ac.uk
Break
Designing passenger information for
dwell time to support Thameslink
high capacity infrastructure
Kate Moncrieff
Network Rail
Requirements for platform display screen design: An Human Factors Approach
Designing Passenger
Information for Dwell Time
An Human Factors Approach
/ 51
Requirements for platform display screen design: An Human Factors Approach
The 24tph dwell time challenge
/ 52
Requirements for platform display screen design: An Human Factors Approach
An Human Factors Approach
An approach for defining
passenger information
needs – Who, what, why,
when, where, how
Defining requirements for
dwell time – Optimise
boarding & alighting and
platform utilisation
Thameslink screen design
development – Calling
points, train pictogram
HF approach to CIS
screen design on a project
– User trials and option
selection
/ 53
Requirements for platform display screen design: An Human Factors Approach
1. Dwell time requirements
- To board a train with confidence passengers must be able to
identify whether a train calls at their destination.
- Information should be provided to prevent passengers from
waiting out of position for their train.
- The number and position of display screens must be
optimised to encourage efficient platform utilisation and to
prevent crowding at pinch points.
/ 54
Requirements for platform display screen design: An Human Factors Approach
Passengers board train with confidence
Platform 1
Station A
Platform 2
Station A
Station B
Station H
Station C
Station I
Station D
Station J
Station E
Station K
Station F
Station L
Station G
Station M
/ 55
Requirements for platform display screen design: An Human Factors Approach
2. Timetable Analysis
12 Service Groups:
Bedford – Brighton
Bedford – Tunbridge Wells
Bedford – East Grinstead
Luton – Ashford International
Luton – Sevenoaks
Bedford – Brighton
St Albans – Caterham
St Albans – Bellingham
Peterborough – Horsham
Welwyn Garden City – Caterham
Cambridge – Three Bridges
Welwyn Garden City – Maldestone East
/ 56
Requirements for platform display screen design: An Human Factors Approach
/ 57
Requirements for platform display screen design: An Human Factors Approach
Stopping patterns
Bedford Services
St Pancras Thameslink
Finsbury Park
Kentish Town
West Hampstead Thameslink
Cricklewood
Brent Cross
Hendon
Mill Hill Broadway
Elstree
Radlett
St. Albans
Harpenden
Luton Airport Parkway
Luton
Leagrave
Harlington
Flitwick
Bedford
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
/ 58
Requirements for platform display screen design: An Human Factors Approach
3. Approach for defining information needs
Who, what, where, when, why?
Passenger journeys
Timetable analysis
Operational requirements
Functionally related requirements
Requirements mapped to decision points
/ 59
Requirements for platform display screen design: An Human Factors Approach
/ 60
Requirements for platform display screen design: An Human Factors Approach
Information needs - examples
Passenger
arrives at
the station
Confirm it is
the correct
station
Passenger
enters the
concourse
Identify journey
from origin to end
station, departure
time and platform
number
Passenger
makes
way to the
platform
Confirm they
are going the
right way
Passenger
arrives on
the
platform
Confirm is
the correct
platform
Passenger
waits on
the
platform
Monitor train
departures.
Identify correct
train and where to
wait.
Passenger
boards the
train
Confirm is
the correct
train
/ 61
Requirements for platform display screen design: An Human Factors Approach
4. Where to wait – train stopping positons
/ 62
Requirements for platform display screen design: An Human Factors Approach
Defining where to wait information
/ 63
Requirements for platform display screen design: An Human Factors Approach
Train loading Vs Dwell time
For ‘business’ the main decision point is at home, on
move, in concourse to decide which train to catch.
It is likely that peak services will always be full and
standing – how useful is this information?
If one carriage were empty would we want
passengers to board through this door – conflicts
with dwell time requirement.
/ 64
Requirements for platform display screen design: An Human Factors Approach
5. HF Approach to CIS screen design
Requirements definition
Include in project requirement specification
Framework for option selection
Requirements attributed to options
HF led option development
User trials and UX screen design
/ 65
Requirements for platform display screen design: An Human Factors Approach
/ 66
Requirements for platform display screen design: An Human Factors Approach
6. Conclusions and next steps…
Functional requirements
can be mapped to station
locations and particular
options.
The number and position
of screens should be
considered to optimise
platform utilisation.
Timetable analysis was
essential and is
recommended to inform
display screen designs.
Input required to the
Project Requirement
Specification in the
absence of a
standard/guidance.
/ 67
Requirements for platform display screen design: An Human Factors Approach
Thank you
/ 68
Tackling the rail worker accident
plateau: applying a psychological
approach
Jim Morgan
Leeds University
Tackling the rail worker accident
plateau: Applying a Psychological
approach to safety
Dr Jim Morgan
WHAT’S
MISSING?
Accident Rates
Rail worker accident plateau
Q: WHAT’S ‘MISSING’?
A: PROACTIVE USE OF BOTTOM-UP DATA
Psychological & behavioural data
•
•
•
Personality / Disposition:
• Global (e.g. Big Five)
• Facet (e.g. sensation seeking)
• Homeostatic regulation / Mood (e.g.
fatigue, stress response, adaptation /
coping capacity)
Cognitive ability:
• Attention (e.g. vigilance)
• Perception (e.g. hazard / risk)
• Decision making (e.g. risk)
Risk appraisal & work (accident)
experience:
• Attitudes (motivations) towards /
experience of safety and risk
• Self-reported accident / incident / nearmiss involvement
PSFs affecting
demands (e.g.
task design,
workload,
downtime,
time pressure)
Environmental
PSFs (e.g.
noise)
Organisational
Factors (e.g.
systems &
procedures,
resources)
Psychosocial
factors (e.g.
supervision/lea
dership,
interpersonal
factors)
Situational factors
VolkerRail OTM interviews
(described at RHF2013)
Summary:
•
•
•
•
•
•
•
•
AIM: To explore perceived factors
influencing OTM accident risk
Also – the efficacy of organisational &
individual safety efforts (when risk is high)
10 OTMs interviewed = 17.5 hours (total)
Analysed by non-subject experts
Data-driven (bottom-up) thematic analysis
2 strong themes emerged, amongst others:
Fatigue
• Fatigue, time pressure, & safety
• Rostering system & shiftwork
• ‘Downtime’
Safety Communication & Training
• Practical-based (versus)
• Soft, transient initiatives
Pilot study: VolkerRail audit
(described at RHF2015)
Psychological
& behavioural data
AIM:
•
•
•
•
•
•
•
Personality / Disposition:
• Global (e.g. Big Five)
To examine individual differences & group
• Facet (e.g.
similarities
in: sensation seeking)
• Homeostatic regulation / Mood (e.g.
Self-reported
accident / incident
fatigue, stress response, adaptation /
involvement,
hazard perception, risk
coping capacity)
decision making,
Cognitive
ability: risk propensity, & risk
taking…
• Attention (e.g. vigilance)
…and
other influencing
• Perception
(e.g. hazardfactors
/ risk) such as
worker
disposition
of
• Decision
making and
(e.g.perceptions
risk)
work characteristics
Risk appraisal & work (accident)
experience:
• Attitudes
towards
/ experience
of safety
Also
to further
explore
the
and risk
interrelationships
between these variables
• Self-reported accident / incident / nearmiss involvement
PSFs affecting
demands (e.g.
task design,
workload,
downtime,
time pressure)
Environmental
PSFs (e.g.
noise)
Organisational
Factors (e.g.
systems &
procedures,
resources)
Psychosocial
factors (e.g.
supervision/lea
dership,
interpersonal
factors)
Situational factors
Pilot study: VolkerRail audit
Methodology summary:
•
•
•
•
•
•
•
•
•
•
Questionnaire contained established measures
(for which psychometric properties tested) +
novel items
Audit questionnaire advertised & administered
across all safety-critical staff
Paper version (sent out with pay slips)
Also online version
Brief by university researchers
Anonymous & confidential
Group level identification possible
146 / 434 response (34% = low)
Power of data analysis restricted (i.e. possible
at level of job type rather than role)
As a pilot study = promising potential
VolkerRail audit: Results
Analysis by areas of work & job type:
•
•
•
•
No significant differences in accident risk
outcome scores
Heat maps identifed ‘areas of concern’ for
each accident risk outcome:
• Self-reported accidents
• Risk taking
• Risk propensity
• Risky decision making
• Risk / Hazard perception
For each ‘area of concern’:
• Influencing factors identified (i.e.
significant correlates)
• Risk factors calculated (potential
strength of influence)
Example depicts results for SPC Engineers
Influencing Factor
n
E
Er
r
P
Safety training
effectiveness
Workload - mornings
5
4.20
(5 – E)
0.80
Risk
Factor
-0.92
84.64
68
5
3.30
-
0.96
92.16
304
Workload - evenings
5
3.27
-
0.96
92.16
301
Hazard perception worry
5
1.90
3.10
-0.98
96.04
298
VolkerRail audit: Influencing factors
KTP and future work
VolkerRail KTP
Amey KTP
Worker group 3
Worker group 4
LBU HF Team Welcomes
Dr Matteo Cucuruto
Expertise in:
•
•
•
•
•
Developing validated measures of:
• Safety Proactivity in organizations
• Organizational citizenship behaviour
• Organizational culture and climate
• Safety motivation
• Safety voice
• Safety leadership
• Safety motivation
Dynamics of trust in organizations
Safety intervention development (for
BASF)
Human/computer-interaction
Multilevel research approaches
ATW Culture change programme
Ian Jonah & Lisette Bartlett
ATW
Safety Improvement Champions
• To focus on individuals to think
about their own safety.
• To recognise the outcome of
unsafe behaviour.
• To recognise and praise safe
behaviour.
• The ability to relate safety to
our workplace.
• Introduce the concept of
Cultural Change.
• Adopt personal responsibility
for our own actions.
Q&A
On behalf of ATW and myself I would like to
thank you for your attention and your
participation today.
I hope it has been informative and beneficial to
you and your organisation moving forward.
Route Knowledge – Facilitating a
standardised approach for GB Rail
Aoife Finneran
Risk Based Training Needs
Analysis Toolkit
Paul Leach
Non-Technical Skills
Mary-Elizabeth Cross
Managing drivers on routes
undergoing significant change
Philippa Murphy
Industry HF SPAD review
Huw Gibson
Transitions to/from ERTMS operation
– impact on operations
Alice Monk
Musculoskeletal disorder risk
Assessment for Train drivers tool
(MAT Tool)
Charlotte Morrison
Guidance and good practice on
Safety culture and behavioural
development
Sarah Hesketh
Managing the risk from fatigue
Dan Basacik
Staff communication on platform
train interface safety: The facts
and their role
Toni Flint
Helping ERTMS, AWS and TPWS
to coexist
Nicholas Bowler
Lunch
Development of a part task training tool
for drivers of light rail vehicles, a sociotechnical system development and
change management tool
Ian Rowe
Ian Rowe Associates
Development of a Part Task Training
Tool for Drivers of light rail vehicles;
A socio-technical system
development and change
management programme.
Ian Rowe
Innovation of the year
Highly Commended
Agenda
•
•
•
•
•
•
Background
Project Approach
Change Management
Results
System Development
System demonstration
Background
•
•
•
•
Manchester Metrolink requirement for Driver Training tool
Pilot system developed
Successful project
60% of Metrolink track now trained in Simulator – Includes
all complex junctions
• Now commercially available. Clients include:
–
–
–
–
–
Manchester Metrolink – Whole system to be included in 2016
Nottingham Express Transit – Whole system included
Birmingham Metro – Extension to New Street
Isle of Man Railways – Douglas to Port Erin
Others …. TBA
What is Tram-Pro
• Part task trainer (RSSB definition)
• Customised training system
–
–
–
–
Environment
Cab
Signalling system
Hazards and operational scenarios
• Replicates driving experience –
behaviour of vehicle and signalling
emulates real life
• Supports multi-workstation
implementation
• Supervisory system to deliver high
trainer to trainee ratio (1:12)
Project Approach - Socio-technical
approach
40% of projects are complete
failures with 40% delivering a
partial success and only 20%
considered as a complete success.
(Clegg and Shepherd 2007)
Change Management
• Training Needs Focused
• Change Management Approach
– Engagement with all stakeholders – early and
throughout
– Appointment of ‘Change Champion’
– Addressing emotional concerns as well as
technical ones
Manchester Metrolink Results
• Reduced training time from approximately 9hrs
per driver to 1hr (East Manchester Line)
• Enables training for sections that cannot be
trained using traditional ‘Minder’ methods
• Train up to 8 drivers simultaneously
• High confidence level of drivers – ‘déjà vu’
experience
• High acceptance level from drivers
• Improved quality by increasing experience
resulting in low incident rate
Simulator training results
Summary of feedback
•
•
•
•
•
•
142 Drivers completed questionnaires
Full range of driving experience (0-20 years)
1269 Questions answered
18 Negative (Disagree or strongly disagree)
98.58% positive response
No correlation between those answering
negatively about use of computers and computer
games and other answers scored negatively
System Development
• Announcing comprehensive implementation
options
– Mobile – Laptops based mobile workstations
– Compact – Desk top based multiple workstations
and supervisory system
– Console – Cab hardware, Multi-screen
– Cab Replica – Life size, cab layout
The un-canny valley
•
•
•
•
Cab Controls
Sound
Cars
Pedestrians
Demonstration
Thank you
Bowtie diagrams: A uder friendly
risk communication tool –
contractor management case study
Claire Turner
ERM Risk
Bowtie Diagrams: A User-Friendly Risk
Communication Tool
Contractor Management Case Study
Claire Turner, ERM & Ian Bradler, Network Rail
Overview
1. Background & Project Goals
2. Bowtie diagrams – theory and practice
3. Golden rules for building effective Bowties
4. Incorporating HF into Bowties
5. Contractor Management Case Study
121
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Background
■ Recognition that more work is required to demonstrate robust and
consistent approach to assessment of occupational health and safety
risks at each stage of the contracting process
■ Point 10 of NR 10-Point Safety Plan is ‘Safe Contractors’
■ Step change in supplier selection, performance management and
assurance, taking a risk-based approach
■ Strategic aim to incorporate risk assessment at early stages of project
lifecycle
■ GRIP 1&2 are light on RA. Scope for additional info/tools
■ ORR Improvement Notices/Letters:
■ Risk assessment, documentation and management insufficient
122
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Project Goal
■ To identify a robust risk-based
contractor management process that
will support effective assurance
programmes (i.e., that appropriate
risk assessments are being
undertaken throughout each stage of
the contracting process).
123
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Project Approach
■ Review of current processes and practices in assessment of
occupational health and safety risk in infrastructure projects
■ Feedback from senior stakeholders on current application of risk
management processes, frameworks and procedures
■ Identification of gaps, disparities and opportunities for improvement
Pilot use of Bowties diagrams as key component of risk
communication throughout project lifecycle
■ Development of Bowties to represent:
■ Key safety risks associated with rail construction projects (based on
lifesaving rules)
■ Potential causes and consequences
■ Good practice in risk controls/barriers: preventative and mitigating
124
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Contractor Engagement
Which hazard register is more likely to engage staff and
contractors?
125
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Bowties – Key Features
Source: Network Rail
3. What are the
primary threats that
may cause loss of
control?
Threat - A possible
cause that will
potentially release a
hazard and produce a
Top Event
Barrier - Prevent threats from
releasing a hazard
4. How can the
event develop
and what are
the potential
outcomes?
Hazard - Something with the
potential to cause harm
(Includes ill health and injury,
damage to property, products or
the environment, production
losses or increased liabilities).
Recover Measure - Limits the impact
of a consequence arising from a Top
Event.
1. What is
the hazard?
Consequence - An
event that results
from the release of a
hazard
Top Event - The release of the
Hazard.
Barriers arranged in the order
they act in time
5. What can be done to
prevent the threat and
keep control?
The world’s leading sustainability consultancy
2. What
happens when
the hazard is
released?
Recovery measures arranged in
the order they act in time
6. What can be
done to recover
from the top event
or to reduce its
impact?
Escalation Factors
127
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Benefits of Bowties
■ Well established tool for risk management – used in high hazard
industries for over 20 years
■ Concise graphical summary of complex risk scenarios – for ease of
communication
■ Accessible – to staff at all levels/roles
■ Adaptable – can be modified to suit specific projects
■ Scaleable – can be applied to projects of different sizes
■ Support risk-based approach – prioritise critical controls/barriers
■ Meaningful – sufficiently detailed to be applicable in a wide range of
projects
■ Allow adequacy of controls to be evaluated for each project,
identification of gaps and allocation of actions/responsibilities
■ Not just a picture but a process – can use to build an entire SMS!
128
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Golden Rules of Bowtie Building
Rule 1
Know what you want to achieve
Rule 2
No numbers
Rule 3
The top event is when you lose control of the hazard
Rule 4
Threats are pre-cursors to the top event
Rule 5
Rule 6
Consequences are discrete credible worst-case
outcomes of the top event
A barrier /control must have an effect and must be
tangible
Rule 7
Only show escalations where this adds value
Rule 8
Human error is not a generic threat
Rule 9
Involve stakeholders
Rule 10
Break any of these rules sooner than do anything
outright barbarous!
129
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GOLDEN RULE #8: Human error is not a generic threat
Slide 130
 Common to see the generic threat “Human Error”
on bowtie diagrams
 Gives little insight into meaningful barriers
 Provides Human Factors “whitewash”
D’OH!
 Human Error should be included as specific threats
or as escalations to barriers
 Understanding the threat allows barriers to be
assessed or defined
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Human Failure in Bowtie Diagrams
Hazard
Human
error
Competence
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Procedure
Alarms
Top Event
Control
1
Consequence
Human Failure in Bowtie Diagrams
Case 1
A specific human
error (performance
failure) can be a
threat provided it has
a defined
consequence and
route of causation to
a top event.
Case 2:
Human
performance
failures can
affect the
performance of
a preventative
control
measure.
Top
Top
Event
Event
Case 3:
Human
performance
failures can
affect the
performance
of a mitigating
control
measure.
Performance influencing factors
Manning levels; fatigue; workload; job design; leadership and supervision;
competence; communications; usability of equipment; working environment
stressors.
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Human Factors in Bowties - Example
Case 1
Case 3
Case 2
Case 3
133
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People as Controls
Threat
Threat
134
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People
act as
the
barrier
People
maintain
the
barrier
Factors Affecting Control Reliability
Focus
Safety critical
tasks
Job role &
responsibility
Process
Questions

What are the tasks to be performed?

Could failure to perform the task properly invalidate the control measure?


Who is responsible for performing the tasks (job roles)?
Who is responsible for supervising the performance of the tasks?
Is there a process defined for the tasks?
Is that process complied with?
Human Machine
Interaction



Are specialist tools or equipment needed for the task?
Is these available?
How is it tested and calibrated (if necessary)?
Manpower
availability



Competence



Are the tasks part of the planned work schedule?
How is this communicated to the people who will perform the task?
Are there sufficient people available to ensure that the tasks are performed in a
timely manner?
How are workload and fatigue managed?
What special knowledge and skills are necessary for the task?
How is the competence to perform the task assured?
Safety critical
communications
Learning and
Improvement


What initiates the performance of the task (i.e. what are the initiating criteria)?
How is the completion of the task reported?



Management of
change


If there are defects how are these reported?
How are deficiencies in the process identified and reported?
How are standards of performance assessed?
How is the process of repair of defects managed?
Who is responsible for implementing required changes to the process?


135
The world’s leading sustainability consultancy
Contractor Management Bowties
■ Create Bowties that represent optimal risk
control strategy for key construction hazards
■ Method of communicating Network Rail’s
expectations about levels of protection to
IP contractors
■ Allow contractors to understand safety risk
management requirements in detail and to
price jobs accordingly
■ Enable identification of gaps in the
management of key risks and facilitate
implementation of best practice.
136
The world’s leading sustainability consultancy
Hazard Selection for Bowties
137
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Bowties Developed with SMEs
138
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Example Bowtie…
139
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…and now a readable(ish) snapshot!
140
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Defining Controls
■ Barrier type – Hierarchy of
controls
■ Accountability - Job role
with accountability for
performance of the barrier
■ Criticality - The degree to
which a barrier is critical in
preventing a threat from
becoming a top event
■ Effectiveness – The
current level of
effectiveness of the barrier
141
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Is the control strategy good enough?
■ Prevention vs mitigation: It is better to rely on preventative controls
then mitigating controls
■ Type of controls: Reliance on engineered controls is a better option
than administrative controls
■ Control effectiveness: Implemented controls should in general have a
good level of effectiveness
■ All threats have implemented controls: All threats need at least one
control to prevent it from leading to the top event
■ Few critical controls: A good control strategy relies on few critical
controls that mitigate a number of threats
■ Each threat has one critical control to prevent it from leading to the
top event
142
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Barrier Analysis
■ Bowtie 1: Falls from Height:
■
12 threats identified & 5 notable consequences
■
53 independent barriers, of which 17 were judged to be highly critical
■
Of highly critical barriers, only 8 were categorised as having good effectiveness, with the remaining nine in need of
improvement
■
The majority of the barriers preventive (72%)
■ Bowtie 2: Contact with live/charged equipment >60V:
■
12 threats, 9 consequences
■
52 independent barriers, 27 highly critical
■
12 critical barriers categorised as having good effectiveness, 13 needing improvement, 2 with low effectiveness
■
81% preventative
■ Bowtie 3: Personnel in path of oncoming train:
■
10 threats, 8 consequences
■
41 independent barriers (of which 4 are future barriers, not yet implemented), 21 highly critical
■
3 critical barriers categorised as having good effectiveness, 16 needing improvement, 2 with low effectiveness
■
68% preventative
143
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Next Steps
■ Address weaknesses identified in
current control strategies
■ Define specific process for
incorporating Bowties into
Network Rail risk management
process for contractors
■ Select pilot project/dummy project
for trial with contractors
■ Collect feedback and
improvements
144
The world’s leading sustainability consultancy
Concluding Thoughts
■ Bowties can be an effective risk awareness, management, audit AND
communication tool
■ Tell the ‘safety story’ of a project throughout lifecycle
■ Allow risk controls to be properly understood and the importance of individual
controls within overall control strategy
■ Enable contractors to understand Network Rail expectations before bidding for
projects and price jobs accordingly
■ Promote effective communication of specific hazards and controls between
Primary Contractor and subcontractors
■ Support frontline supervision
■ Can be used by Network Rail as a project safety assurance tool, to check the
risk management measures in place against those defined in the Bowtie
■ Demonstrate clear and systematic approach to risk management to regulatory
authorities
145
The world’s leading sustainability consultancy
In Summary…
Bowties are great! Let’s use them widely and wisely for rail
risk management and communication.
146
The world’s leading sustainability consultancy
The End
Thank you for listening.
claire.turner@erm.com
147
The world’s leading sustainability consultancy
Importance of identifying and
including representative users
throughout design
Suzanne Heape
Siemens
Suzanne Heape Siemens RA 4 February 2016
Importance of Identifying and
Including Representative Users
Throughout Design
Agenda
Introduction
Why
Barriers
Case Study
Conclusion
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2015-09-16
Suzanne Heape
Railways Are Changing
Complex and Highly Automated
Fewer workers using complex equipment under pressure
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2015-09-16
Suzanne Heape
Meeting New Challenges
Faster, Bigger, Safer, Cheaper
Requirement: the highly skilled, motivated,
productive, and ever vigilant worker
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2015-09-16
Suzanne Heape
Answer?
You Cannot Create a User to Fit the System
But You Can Create a System to Fit the User
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2015-09-16
Suzanne Heape
Requirements:
Ambiguous and Flawed?
Ask the User
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2015-09-16
Suzanne Heape
Human Factors
Human Centred Design
Human Factors (HF) is
concerned with the ‘fit’ between
the user, equipment and their
environments.
HCD
HF experts use scientific
methods to include the
expert user in design
decisions and evaluation
Adapted from IDEO Human Centred Design Toolkit
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2015-09-16
Suzanne Heape
Barriers to User Engagement
Deficiencies in:
Structured
Approach
& Common
Insight
Stakeholder
Involvement
User
Location
and Trust
Project
Sponsorship
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2015-09-16
Suzanne Heape
Overcoming Barriers
Alter Perception
To overcome barriers:
Must secure trust &
promote self-interest
Venkatesh & Bala, 2008
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2015-09-16
Suzanne Heape
Overcoming Barriers
Plan
Without a
structured methodology
optimum safety, usability,
and effectiveness of the
system will not be achieved
ISO 9241 – 210 User Centred Design
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2015-09-16
Suzanne Heape
Overcoming Barriers
Key Documents
HF Integration Plan • Identifies all activities for a suitable level
and Programme
of HF integration
guidance to be used to ensure
HF Design Guide • HMI
consistent design across all HMIs
HF Requirements
and Issues Logs
HF Assurance
Case
• Prioritised requirements for optimal design
• Validated issues tracked to close
• Details compliance with plan and
requirements, and closure of issues
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Overcoming Barriers
Stakeholders
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Suzanne Heape
Overcoming Barriers
Core User Group
Involved from Concept to Implementation
• Attributes Required:
• Represent all relevant roles
• Experienced in role & use and maintenance of current systems,
• Detailed knowledge of railway assets and infrastructure
• Expected to use new systems
• Open minded to change
• Credible and well-respected by others
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2015-09-16
Suzanne Heape
Overcoming Barriers
User Input When it Matters
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2015-09-16
Suzanne Heape
Overcoming Barriers
User Input Where it Matters
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Page 163
2015-09-16
Suzanne Heape
VLU Users from Threat to
Success
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2015-09-16
Suzanne Heape
Case Study
Victoria Line Upgrade
New Signalling and Train
Control System
New Trains
Increased capacity from 24
to 33 tph
Successful completion for
Olympics 2012
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Suzanne Heape
VLU Project HF Status in 2006
No HF budget
Negative perception of HF
No qualified HF Delivery Manager or
Internal HF expert
Minimal unsatisfactory HF activity using
HF Consultancies
Inadequate engagement of Users
Engagement Process Standoff
No User acceptance -risk of project failure
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Suzanne Heape
Re-start User Engagement
Users see their input reflected in system
User-system ownership and acceptance
Undertake User Engagement Activities
User changes included in system
Re-start steering group Ops and HF
Address UAM and Ops complaints
Review and Re-plan HF activities,
Detail user engagement activities
Appoint a HF Delivery Manager
HFDM commences activities
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2015-09-16
Suzanne Heape
Fewer Meetings More Workshops
Prototyping
Information Sorting
High
Medium
Low
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Vanguard Team
Representative users
Recruited at preliminary design phase
Consistently involved through to finish
Product
Optimisation
User Ownership
Expert
Operations Staff
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Suzanne Heape
Victoria Across the Finish Line
VLU completed upgrade for London Olympics in 2012
2012 TfL Announced VLU
Best Performing Line Over the Olympics
Transport for London website June 2014
“Passengers on the Victoria line are now benefitting from the
most frequent train service in the UK - up to 34 trains per hour.
The service, which means customers wait less than two minutes
between trains arriving on platforms in peak times, will provide
additional capacity for thousands of extra passengers.”
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Suzanne Heape
Conclusion
Status
Automated
Railways
Operator
role
complex &
demanding
Operator
task
Design
Challenge
Monitor &
maintain
Remain
vigilant
when
effectively
underutilised.
Balance
operator
workload
& maintain
operator
situation
awarenes
s
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2015-09-16
Answer
Result
Include
users in
design to
clarify
complex
needs &
ensure
user
approval
System
fit-forpurpose,
Efficient,
effective
safe, &
easy to
use
Suzanne Heape
suzanne.heape@siemens.com
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Suzanne Heape
Break
A cow with a pantograph: a review
of driver signaller communication
for EU interoperability
Bev Norris
Interfleet
›
The cow with the
pantograph
›
A review of driver-signaller communication
for EU interoperability for the ERA
Beverley Norris, Andy Woodcock, Jane Dobson, Kate Dobson
17
6
Interfleet is now SNC-Lavalin Rail and Transit



Founded in 1911, SNC-Lavalin is one of the largest global engineering and
construction companies, working across 50 countries
“Interfleet” now leads the global Rail and Transit division
A growing Human Factors team:
Wendy
McCristal
Alison Moors
Di Hartley
Martin
Stoudt
Abigail
Fowler
Beverley
Norris
George
Charalambous
Kate
Dobson
Derby
Derby
Derby
London
Derby
Derby
London
Vancouver
17
7
...”une vache avec
le pantograph.....”
17
8
17
Technical Standards for Interoperability
19
(TSIs)
7
9
› TSI (NOI)
Noise
› TSI (LOCPAS)
Locomotive & Passenger
› TSI (WAG)
Rolling Stock (Freight Wagons)
› TSI (INF)
Infrastructure
› TSI (ENE)
Energy
› TSI (CCS)
Control Command and Signalling
› TSI (OPE)
Operation and Traffic Management
› TSI (TAF)
Telematic Applications for Freight
› TSI (TAP)
Telematic Applications for Passenger Services
› TSI (PRM)
Persons with Reduced Mobility
› TSI (SRT)
Safety in Railway Tunnels
› TSI
Conformity Assessment Modules
18
0
TSI OPE
Appendix C Safety related railway communication
methodology
Received
Over
Wait
I call
again
› Standard terminology
Correct
› Confirming understanding
› Single digits
147
One – four-seven
› Phonetic alphabet
›
› Standard terms for distance Km, speed Km/h, time
Error
I say
again
TSI OPE Appendix C
Safety related railway communication methodology
› Identification phase
› Read back of key messages
› Structure and content of emergency & additional messages
› Written orders/book of forms
18
1
1
8
2
Compliance with
Appendix C?
Nei
Ja
Nej
Ja
Ja
Oui
Ja
Nee
Nein
Non
Sim
No
Si
Taip
Ano
Ne
Si
No
Da
ERA commissioned study
›
Aims
› To understand communication methodologies across EU and
compliance with TSI OPE Appendix C
› Review literature for principles of effective safety communication &
a link to safety performance
› Verify Appendix C is still appropriate
› Identify further improvements
›
18
3
Methodology
Literature Review
Interview Survey
Assessment Framework
18
4
18
5
Methodology

Literature Review
Interview Survey
Assessment Framework
Rail and other industries - aviation, emergency response,
healthcare and defence
18
6
Methodology
Literature Review
Interview Survey
Assessment Framework
•
•
•
•
Structured questionnaire
Individual communication procedures
Attitudes to Appendix C
Wider organisational issues - selection and training; monitoring;
safety culture
18
7
Methodology
Literature Review
Interview Survey


Assessment Framework
To benchmark communication methodologies
the link to safety
FINDINGS
A review of driver-signaller communication for EU
Interoperability
What the literature says about formal
communication
› Formalised, defined & constrained messages help avoid language
failures
› A balance is needed
› Workarounds will appear if very frequent, non-critical messages
are too formal
› Structured communication protocols need to be backed up with
ongoing training and monitoring
› Joint signaller/driver training is beneficial
18
9
19
0
Interview sample
27 organisations across 9 EU member states
• 11 Infrastructure Managers (IMs)
• 14 Railway Undertakings (RUs)
• 2 Standards/Regulatory bodies
Stratified sample to represent:
• Passenger and freight
• National/international operations
• Purpose built links
Eurostar, Øresund Bridge
• Historic cross-border railway routes
Perpignan – Figueres
›
1
Survey - international rail operations
Less than 10 border crossings
Between 10 and 30
More than 30
 Most EU rail networks have over 10 border
crossings.....up to 50!
 However a very small proportion of trains
operated are on international services (max 3%)
 Regulatory overkill??
19
1
19
2
There is general good compliance with App. C
›
But compliance varies across parts of Appendix C
Yes
No
In part
What they say:
• “Appendix C considered a useful contribution to railway safety”
• “Requirements should be reinforced”
• “Weaknesses - simplify, translations to account for different cultures”
Compliance with Appendix C - terminology
 Standardised date, distance & speed
 (89%)
 International phonetic alphabet, single digits
 (81%)
 Correct / Error and I say again
 (59%)
 I will call again
 (52%)
19
3
Compliance with Appendix C - procedures
 Identify lead person
 (85%)
 Emergency messages to be repeated
 (81%)
 High priority messages skip ID
& send whilst moving
 (78%)
 Request read-back
 (67%)
 Glossary
 (48%)
19
4
Additional messages and written orders/book of
forms
•
Most organisations have them in their communications
framework
•
But not all comply with App. C requirements e.g.
‘Error and [different form]’ - 36% IMs
•
Written messages - assumption of accuracy?
19
5
Wider issues:
Bi/multi-lingual challenges
19
6
1 language
2 languages
3 or more
• Recruiting bi/multi-lingual staff is problematic
• Terminology/jargon/dialect differences:
“Bahnbübergang” (Germany)
“Eisenbahnkreuzung” (Austria)
What they say:
› “Need bi-lingual border signallers”
› “A single language for international rail communications”
Selection, training & monitoring
•
•
•
•
›
›
Selection - focus is on language proficiency rather than communication
skills
Joint training of signallers and drivers being introduced, but expensive
Monitoring: ~100% of calls are recorded
BUT, the number reviewed varies (max 5%)
What they say:
• “Communication discipline needs to be maintained
– younger versus older drivers”
19
7
Assessment framework
A review of driver-signaller communication for EU
Interoperability
19
9
Austria
Belgium
Czech
Republic
France
Germany
Italy
The
Netherlan
ds
Spain
Sweden
United
Kingdom
Eurostar
Eurotunne
l
App. C & principles of effective communication
Phonetic alphabet


X
P

X


P



Standard 24 hour format
for time
Standard format for date
P



P







X



X
X
P

P
P


Standard format for km &
km/h
Single digits









P


P

P

P


P



Confirm read back correct
X

P

P
n/a


P
P


Glossary of terms


P
P
X

P
X
X
P

X
Book of forms








P
P


Written order









P


Should be sent at
standstill
Emergency messages to
be repeated once
Lead responsibility
X



P

P`

P




P
P


X


















Criteria from
Appendix C
P=complies
in part
Good
OK
Could
improve
Poor
20
0
Austria
Belgium
Czech
Republi
c
France
German
y
Italy
The
Netherla
nds
Sweden
United
Kingdo
m
Eurostar
Eurotun
nel
Wider organisational issues
Are there regular briefings regarding
communications (3-6 months)?





1/yr

1/yr



Have there been any
communications
initiatives/campaigns in last 5 years?




x
x





Is there 100% recording of calls?

90%
70%








0-5%
?
0-5%
0-5%
0-5%
0-5%
5-10%
5-10%
>20%
Is communication competence
formally assessed during selection
(other than language proficiency)?
Is there combined signaller and
driver training?

X
X
X
X
X



X
X
X
X


X
X

X
X

X
Are role play or simulators used
during communications training?
X

X



X
X



Is lead responsibility established
during the call?











P=complies
in part
Good
Have any communication aids been
developed




X




X
X
OK
Is communication supported by text
messages?


X
X
GSMR
only
GSMR
only

X
Planne
d
Is communication supported by
email?


X
X
X
X
X
X
X
Criteria
What % of recorded calls are
regularly reviewed?
GSMR
only
X
X
0
0-5%
Could
improve
Poor
20
1
Leading/lagging countries based on all criteria
Lagging
France
and
Content
Appendix C
withstructure
Compliance
Size of bubble =
% of international
traffic in each country
Leading
Belgium
The N etherlands
UK
Czech Republic
Sweden
Germany
Italy
Austria
Communication framework
Organisational
factors
Lagging
Leading
20
2
Conclusions
› It is difficult to demonstrate App. C will improve safety
performance
› Appendix C is useful but needs to be simplified
› Basic principles such as the phonetic alphabet and repeat back
need to be reinforced
› A standard glossary - easy to access in the cab
› Translations need to be reviewed
› Bi-lingual signallers
› Communication methodologies need to be part of wider safety
initiatives
Merci
Bev.Norris@snclavalin.com
The non-technical skill conundrum:
can you give people better nontechnical skills?
Emma Lowe
Network Rail
Non Technical Skills
Conundrums
Emma Lowe, Competence Manager,
Network Operations
May 2015
205
Conundrums?
How can anyone walk out of a
room on two legs and return with
six?
Date 00.00.00
206
NR’s CORE NON TECHNICAL SKILLS
Date 00.00.00
207
NTS Programme
Recruitment
Training
Assessment
Development
• Situational
Judgement Test
• Experience
assessment
• Integrating NTS
into initial training
• Integrating into
existing
competence
assessment
processes
• Toolkit to support
self learning
• NTS assessor
training for
managers
• Enhanced
refresher training
• Targeted NTS
training
• On the job
coaching
• Self assessment
Date 00.00.00
208
The Conundrums
• How do we explain the concept of non-technical skills when the very
name they have acquired states what they are not and doesn’t clarify
what they really are?
• How do we get people’s attention when many don’t see the relevance
of non-technical skills?
• How do we stop NTS becoming just another “tick in the box”?
• What’s the best way to develop expertise in the skills particularly in an
environment where ‘keeping the job going’ is the top priority?
• How do people learn to change their non-technical skills: is it critical to
understand the underlying psychology or can we just focus on the
practicalities?
• How do we embed the skills such that they are not seen as an optional
extra?
Date 00.00.00
209
Emerging Lessons
• the importance of the prevailing competence culture
• the importance of training in a practical context
• the need to invest in ‘selling’ the concept of non technical skills
• the pivotal role of the line managers and trainers
• making the theory of non technical skills meaningful to the
frontline operative
Date 00.00.00
210
Competence Culture
• balancing
development with
assurance
• optimising learning
opportunities
• making “developing
people” a core
competence for
managers
DEVELOPMENT
ASSURANCE
5-Feb-16
211
Integrating NTS…NTS by stealth
The Process
What can go
wrong and why
Practical
Strategies
Date 00.00.00
• What steps are involved in taking a line
blockage
• Attention Management
• Communications
• Planning and Decision Making
• Shift handover scripts
• Use of reminders
• Active listening
212
Branding
• What’s in a name?
–Human performance skills
–Core skills
–Skills for railway operations
• Having a language that everyone
understands
–Cognitive??
–Situational awareness??
• Real life stories
Date 00.00.00
213
Evaluating the impact of NTS
• Case studies
• Better understanding of hero behaviour and how mistakes are
avoided
• Structuring site observations - Normal operations monitoring
• Changes in self perceptions – peer review
• Team trust measures
• Employee engagement
• Time to competence
Date 00.00.00
214
Summary
• There are barriers that prevent us embedding and realising the
benefits of NTS
• Lessons to date suggest we need to continually focus on:
– being marketing experts and selling NTS
– being culture change experts and creating a competence
culture
– being researchers and evaluating the impact of NTS
arrangements as we go and in a variety of different ways
– being learning and development specialists and finding
innovative ways to deliver NTS training
215
Closing remarks