Aviation Safety Action Programs

1. Aviation Safety Action Programs Training Module F: Participating in the ERC Meeting Version Date: 30 April 2012

2. Welcome and Instructions • Instructor introduction • My ASAP background • Other relevant information • Housekeeping logistics • Duration/schedule, meeting room details, travel logistics, restrooms, expectations for asking questions, breaks, emergency information

3. Student Introductions • Name • Affiliation • Level of experience with ASAP • Something interesting (i.e., fun fact)

4. Overview of ASAP Training • Training materials have been developed for: • Module A: Building ASAP Foundations • Module F: Participating in the ERC Meeting • Module F builds upon Module A • Module A should be completed before Module F • Modules are being developed one at a time • Modules A and F—which cover the actual ASAP report review process—were deemed the two most critical modules, and, thus, developed first

5. Overview of ASAP Training (Cont’d) • Other training modules yet to be developed • Module B: Training ASAP Stakeholders • Module C: Collecting ASAP Reports • Module D: Preparing for the ERC Meeting • Module E: Facilitating the ERC Meeting • Module G: Performing Post-ERC Meeting Tasks • Module H: Analyzing ASAP Data • Module I: Communicating ASAP Data and Results • Module J: Conducting Internal ASAP Reviews • Module K: Managing Multiple ASAPs (if appropriate)

6. Module F: Overview of Contents • Presentation of materials is logical • Roughly follows the order in which the ERC should complete its duties • Presented in a serial manner, though the ERC's work often requires an iterative process • Materials include the best of all information available about the program • FAA ASAP guidance and industry best practices • Audience consists of current or future members of an ASAP that is up and running

7. Module F: Overview of Objectives OVERVIEW • At the completion of Module F, given these training materials as well as ASAP guidance materials and supporting resources course participants should be able to: • Obj 1 Describe the ERC and the purpose and processes of the ERC meeting • Obj 2 Apply teamwork strategies to the ASAP report review process • Obj 3 Conduct a thorough ASAP report investigation • Obj 4 Determine ASAP report acceptance • Obj 5 Reach consensus on the key decisions regarding an accepted ASAP report to determine its disposition • Obj 6 Determine and communicate the appropriate corrective action(s) and/or recommendation(s) • Obj 7 Determine the disposition of an accepted non-sole-source ASAP report with sufficient evidence of an apparent violation

8. Module F: Introduction • Purpose of the training • Provide the knowledge, tools, and strategies necessary for ERC members and ASAP Managers to overcome challenges and be successful • Introductory Video • "Challenges for ASAP" presentation made in 2003 by Dr. Thomas R. Chidester, Aerospace Human Factors Scientist with specialized experience in ASAP • Describes high-level ASAP challenges

9. Challenges for ASAP and Strategies for Mitigating • Identifying contributing factors • Strategies for accomplishing presented in Objective 3 • Handling a high volume of data • Strategies for accomplishing presented in Objective 3 • Recommending corrective action(s) beyond individuals • Strategies for accomplishing presented in Objective 6 • Providing operational feedback/publication • Strategies for accomplishing presented in Objective 6

10. Outline for Objective 1 OVERVIEW Describe the ERC and the purpose and processes of the ERC meeting Topics (T) and Activities (A): T1-1 Purpose, roles, and responsibilities of the ERC T1-2 Overview and purpose of the ERC meeting T1-3 Consistency in the ASAP report review process A1-4 Practice applying a consistent strategy for reviewing ASAP reports OBJECTIVE 1 OBJECTIVE 2 OBJECTIVE 3 OBJECTIVE 4 OBJECTIVE 5 OBJECTIVE 6 OBJECTIVE 7

11. T1-1: Purpose, roles, and responsibilities of the ERC OBJECTIVE 1 Purpose of the ERC • Ensure investigation of ASAP reports • Identify causal contributor(s) of reported event and determine corrective action(s) and/or recommendation(s) to: • Reduce/eliminate likelihood of recurrence of that event • Improve aviation safety • Communicate safety threats to stakeholders • Track completion • Follow of a consistent process

12. T1-1: Purpose, roles, and responsibilities of the ERC OBJECTIVE 1 Responsibilities of the ERC • Review and analyze submitted ASAP reports • Determine whether reports qualify for inclusion in program • Identify actual or potential threats to safety from information in reports, additional data gathered, and resulting analysis • Specify corrective action(s) and/or recommendation(s), if applicable • Use consensus to make critical decisions

13. T1-1: Purpose, roles, and responsibilities of the ERC OBJECTIVE 1 Qualities of a Successful ERC Member • Commitment to safety • Expert knowledge about work of represented employee group, such as: • Work processes and changes in work over time • Policies, procedures, and regulations that guide the work performed • Tools and equipment used • Understanding of Threat and Error Management (TEM) model or other root cause analyses process

14. T1-2: Overview and purpose of the ERC meeting OBJECTIVE 1 Purpose of the ERC Meeting • Use information provided in ASAP report and gather additional information to: • Discuss and review each ASAP report • Reach consensus on several key decisions • Identify causal contributor(s) of the event • Use a consistent process to review each report • Develop or adopt tools or processes to ensure consistency (e.g., checklist, flowchart, decision tree)

15. T1-2: Overview and purpose of the ERC meeting OBJECTIVE 1 Report Review Process: Overview • Legend

16. T1-2: Overview and purpose of the ERC meeting OBJECTIVE 1 Report Review Process: Part 1 • Report acceptance process

17. T1-2: Overview and purpose of the ERC meeting OBJECTIVE 1 Report Review Process: Part 2 • Process result (i.e., decision to accept or not)

18. T1-2: Overview and purpose of the ERC meeting OBJECTIVE 1 Report Review Process: Part 3 • Determination of the disposition

19. T1-2: Overview and purpose of the ERC meeting OBJECTIVE 1 Report Review Process: Dispositions • Accepted reports: • ERC response • FAA Letter of No Action • Administrative or Informal Action • Excluded reports: • Refer knowledge of the event to FAA • Refer knowledge of the event to regional flight surgeon • Refer actual ASAP reports that involve Big 5 violations (i.e., criminal activity, substance abuse, controlled substances, alcohol, or intentional falsification) to FAA

20. T1-3: Consistency in the ASAP report review process OBJECTIVE 1 Benefits of a Consistent Review • Ensures timely review of reports • Ensures each report is reviewed thoroughly • Encourages informed discussion by ERC members • Builds trust among ERC members • Helps get ERC back on track if members are having trouble reaching consensus • Helps ensure underlying causes of events are identified and reduced or eliminated

21. T1-3: Consistency in the ASAP report review process OBJECTIVE 1 Strategies for a Consistent Review • Require ASAP Manager and ERC members have clear understanding of the report review process • ASAP Manager, ERC members and their alternates are to be thoroughly trained before taking on responsibilities • Adhere closely to internal/external policies and procedures as well as ASAP guidance materials and supporting resources

22. T1-3: Consistency in the ASAP report review process OBJECTIVE 1 Strategies for a Consistent Review (Cont'd) • Ensure resources are readily available during ERC meetings to facilitate/promote their use • If one doesn't already exist, develop a manual of ERC processes and procedures (e.g., an ERC SOP) • Adopt a process that is consistent from one report to the next • Following the FAA's ASAP Report Process Chart, or something similar, step-by-step may help members focus on the ERC's required tasks and aid them to make better decisions

23. A1-4: Practice applying a consistent strategy for reviewing ASAP reports OBJECTIVE 1 Practice Applying a Consistent Report Review Process • What strategies can an ERC use to ensure consistency in the report review process? • Spend some time brainstorming independently and then we will share ideas with each other

24. Outline for Objective 2 OVERVIEW Apply teamwork strategies to the ASAP report review process Topics (T) and Activities (A): T2-1 Team-building strategies A2-2 Practice team-building behaviors T2-3 Consensus-building strategies A2-4 Practice consensus-building behaviors T2-5 Conflict management strategies A2-6 Practice conflict management behaviors OBJECTIVE 1 OBJECTIVE 2 OBJECTIVE 3 OBJECTIVE 4 OBJECTIVE 5 OBJECTIVE 6 OBJECTIVE 7

25. T2-1: Team-building strategies OBJECTIVE 2 Team-building Behaviors • Build trust • Ensure quality communications • Embody key personal characteristics • Implement consensus-building strategies • Monitor performance • Provide support

26. T2-1: Team-building strategies OBJECTIVE 2 Build Trust • Show value in opinions/knowledge of others • Ask questions to capitalize on the experience of other members • Share information with fellow ERC members that cannot be shared outside the ERC • Demonstrate the ability to consider the "big picture" by acknowledging situational factors • Express confidence in the member responsible for completing individual tasks

27. T2-1: Team-building strategies OBJECTIVE 2 Ensure Quality Communications • Verbal communication strategies: • State points and ideas clearly and briefly, maintain an even tone of voice, summarize points made to ensure understanding, ask questions when there is lack of understanding or clarity • Listening strategies: • Wait until another member has finished before speaking, use appropriate body language, make eye contact, refrain from distracting activities

28. T2-1: Team-building strategies OBJECTIVE 2 Embody Key Personal Characteristics • Be professionally mature • Be open-minded • Possess integrity • Have belief in shared goal of improving safety • Display trust in ASAP and pride in being part of the ERC through words and actions • Be willing to set aside personal/organizational biases and to compromise

29. T2-1: Team-building strategies OBJECTIVE 2 Monitor Performance • Build on positive interactions • Identify patterns of positive interactions • Recognize and/or reward positive behaviors • Codify and add positive patterns to the ERC Standard Operating Procedures (SOP) Manual, if appropriate • Eliminate or minimize negative interactions • Identify reason (e.g., specific report type, personality issues) and resolve as appropriate • Ask non-voting ASAP Manager to provide an unbiased perspective and possible suggestions

30. T2-1: Team-building strategies OBJECTIVE 2 Provide Support • Make an effort to understand responsibilities of ASAP Manager and fellow ERC members • Offer assistance with tasks if another team member is overloaded • Make suggestions or provide advice or feedback when appropriate

31. A2-2: Practice team-building strategies OBJECTIVE 2 Practice Team-Building Behaviors • We need 3 volunteers for this activity • Each volunteer will be assigned a role on ERC • Certificate holder, FAA, or employee group representative • We will practice team-building behaviors assuming assigned roles • We will use Sample ASAP Reports to practice

32. A2-2: Practice team-building strategies OBJECTIVE 2 Practice Team-Building Behaviors (Cont'd) • What could you say or do to show the certificate holder/FAA/employee group representative that you: • Value his or her opinion? • Appreciate the situational factors that may have contributed to the event? • Want to capitalize on the experience of the certificate holder/FAA/employee group representative?

33. T2-3: Consensus-building strategies OBJECTIVE 2 Reach Consensus: Definition • "Voluntary agreement of all ERC members to each decision required by the MOU" • Must fall within each ERC member's range of acceptable solutions • Resulting decision should be in best interest of safety • If consensus is not reached on decisions concerning an ASAP report involving an apparent violation(s), a qualification issue, or a medical certification or qualification issue, the FAA ERC representative will decide how the report should be handled

34. T2-3: Consensus-building strategies OBJECTIVE 2 Reach Consensus: Key Decisions • There are several critical decisions about which the ERC must reach consensus, including, but not limited to: • Acceptance or exclusion of report • Designation of report as sole-source or non-sole-source • Assessment of risk associated with the event • Development of corrective actions and recommendations • Final disposition of the ASAP report

35. T2-3: Consensus-building strategies OBJECTIVE 2 Reach Consensus: Strategies • Practice • Set and document conduct rules in ERC SOP • Ask questions to ensure discussions are based on an accurate understanding of issues • Be open to other points of view • Anticipate perspectives of other members by considering how they will view the issue • Focus on the facts

36. A2-4: Practice consensus-building behaviors OBJECTIVE 2 Practice Consensus-Building Behaviors • We need 3 volunteers for this activity • Each volunteer will be assigned a role on ERC • Certificate holder, FAA, or employee group representative • We will practice consensus-building behaviors assuming assigned roles • We will use Sample ASAP Reports to practice

37. A2-4: Practice consensus-building behaviors OBJECTIVE 2 Practice Consensus-Building Behaviors (Cont'd) • What could you say or do during this ERC meeting to help the team to: • Build consensus on the appropriate corrective action and/or recommendation? • Encourage ERC members to state their perspective? • How might you know during an ERC meeting that a member is having difficulty seeing the situation from another member's point of view?

38. T2-5: Conflict management strategies OBJECTIVE 2 Manage Conflict: Strategies • Refer often to the MOU as well as ASAP guidance materials and supporting resources • Work to ensure that all information about a report and any policies regarding how to address it are understood by all • Continue to gather information about event • Look at issues from the other ERC members' points of view • Re-center the group on the facts

39. T2-5: Conflict management strategies OBJECTIVE 2 Manage Conflict: Strategies (Cont'd) • Take a break to give members a few minutes to step away from the discussion and clear their thoughts • Delay discussion or resolution of a report until the next meeting • Bring in alternate ERC members • Bring in a conflict resolution specialist

40. A2-6: Practice conflict management behaviors OBJECTIVE 2 Practice Conflict Management Behaviors • We need 3 volunteers for this activity • Each volunteer will be assigned a role on ERC • Certificate holder, FAA, or employee group representative • We will practice conflict management behaviors assuming assigned roles • We will use Sample ASAP Reports to practice

41. A2-6: Practice conflict management behaviors OBJECTIVE 2 Practice Conflict Management Behaviors (Cont'd) • What are words that you might hear or behaviors you might see that indicate that the ERC is in conflict? • What could you say or do during an ERC meeting to: • Manage conflict? • Encourage additional productive discussion about the event?

42. Outline for Objective 3 OVERVIEW • Conduct a thorough ASAP report investigation • Topics (T) and Activities (A): • T3-1 Initial review of the ASAP report • T3-2 Event type and causal contributor taxonomies • A3-3 Practice applying an event type taxonomy to an ASAP report • A3-4 Practice applying a causal contributor taxonomy to an ASAP report • T3-5 Methods for collecting and evaluating information beyond that included in the ASAP report • A3-6 Practice conducting investigative tasks during an ERC meeting OBJECTIVE 1 OBJECTIVE 2 OBJECTIVE 3 OBJECTIVE 4 OBJECTIVE 5 OBJECTIVE 6 OBJECTIVE 7

43. T3-1: Initial review of the ASAP report OBJECTIVE 3 Conduct an Initial Review of the ASAP Report • Assess risk to determine whether the safety-related event represents a substantive threat to safety • Evaluate severity of event and likelihood of recurrence • Typically performed by the ASAP Manager, who has immediate access to incoming ASAP reports • Give immediate attention to high risk events • May require an emergency meeting of the ERC

44. T3-1: Initial review of the ASAP report OBJECTIVE 3 Conduct an Initial Review of the ASAP Report (Cont'd) • Anticipate and gather additional information likely to be needed to determine the disposition of a report • The ASAP Manager may want to gather additional information in advance of the ERC meeting to allow the ERC to be more efficient in processing reports • Goal is to gather additional information, not to evaluate it • It is the ERC's responsibility to evaluate the information as a team

45. T3-2: Event type and causal contributor taxonomies OBJECTIVE 3 Best Practice for ASAP Report Collection • Require ASAP report submitters to: • Identify event type and causal contributor(s) • Use taxonomies (i.e., classification systems) to do so • ASAP Manager may review this information during initial review of the report • ERC should also consider and evaluate it during their report review process

46. T3-2: Event type and causal contributor taxonomies OBJECTIVE 3 Overview of Event Type, Causal Contributor(s), and Taxonomy • Event type: the kind of safety-related event that occurred • E.g., altitude deviations, weight and balance errors • Causal contributors: factor(s) that caused the event to occur • E.g., confusing policy, lack of training, distraction • Taxonomy: a classification system that provides well-defined and standardized options from which submitters can choose

47. T3-2: Event type and causal contributor taxonomies OBJECTIVE 3 Importance of an Effective Taxonomy • Improves quality of data collected • Provides an important source of information regarding root cause(s) of an event • Helps identify reports with common elements • Facilitates communication about ASAP reports within certificate holder and industry • Order 8900.1 recommends adopting part or all of the endorsed national taxonomy from the Aviation Safety Information Analysis and Sharing system or ASIAS

48. T3-2: Event type and causal contributor taxonomies OBJECTIVE 3 Characteristics of an Effective Taxonomy • Contains a comprehensive set of non-overlapping categories • Uses terminology familiar to stakeholders • Provides definitions and examples • Provides a way to record "other" issues that may not be reflected in existing taxonomy • Requires submitters to select a category from a list of categories within taxonomy

49. T3-2: Event type and causal contributor taxonomies OBJECTIVE 3 Example Taxonomy of Event Types for Dispatchers • Communication • Computer Problems • Equipment • Notices to Airmen (NOTAM) • Reporting of Field Conditions (FICON) • Ops Control • Planning • Policy • Release • Weight & Balance

50. A3-3: Practice applying an event type taxonomy to an ASAP report OBJECTIVE 3 Practice Applying an Event Type Taxonomy • Silently read and carefully review the Sample Dispatch Report for this activity • Envision that you are in a dispatch ASAP ERC meeting • Write down what you believe is the correct assignment from the dispatch taxonomy on the previous slide