Page 145 - Serious Incident Prevention How to Achieve and Sustain Accident-Free Operations in Your Plant or Company

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122 Serious Incident Prevention

dents requires attention to the old adage, “Big doors swing on little hinges.”
Individuals accountable for performance must pay attention to the details—
the condition of each hinge is critical.

Characteristics of Effective Measurement

and Feedback Systems

Processes for sustaining serious-incident-free operations must be for-
ward looking rather than driven by after-the-fact reactions to incidents.
After-the-fact knowledge cannot replace losses. Knowing that a ship has not
sunk or experienced major damage during past operations has limited value
in preventing or predicting future events. The seaworthiness of a ship must
be judged on detailed knowledge of the crew and craft. Proactive knowl-
edge is required to help ensure that conditions necessary to sustain incident-
free operations are consistently maintained.
The focus of measurement should be on actions and conditions that di-
rectly impact serious-incident-free operations. For a ship, key areas of
measurement might include the condition of the ship’s hull, the skill level
of the crew, and the reliability of the navigational system. For a pipeline op-
eration, measures should address critical factors that reflect the capability
of the system to sustain incident-free operations, i.e., the condition of the
pipe, cathodic protection systems, and right-of-way. While a low injury fre-
quency is a favorable indicator of the potential for outstanding performance
by both the ship and pipeline crews, an injury frequency measure does not
sufficiently reflect the status of workplace conditions necessary to sustain
serious-incident-free operations. While some overlap exists, prevention of
common injuries and prevention of serious incidents are two separate
processes and should be recognized as such.

Measurement Systems

The objective of measurement is to monitor actual performance com-
pared to expectations. Characteristics of an effective measurement system
include:

Influenceable—Performers directly influence the measured results.
Meaningful—The items measured are important to the performer
and organization.