Procedures as a productivity and safety tool Jean-Yves Fiset, Eng., Ph. D. jyfiset@shumac.qc

1. Procedures as a productivity and safety toolJean-Yves Fiset, Eng., Ph. D.jyfiset@shumac.qc.ca

2. Outline Why bother? What is in a procedure What procedures can do for you Issues and tips A case study: abnormal situation management Resources

3. Why Bother? Human Performance Analysis of Industrial Radiography Radiation Exposure Events http://www.osti.gov/bridge/servlets/purl/147724-h3ucf2/webviewable/147724.pdf In Preliminary Findings, CSB Investigators Report Bayer CropScience Explosion Was Caused by Runaway Chemical Reaction; Cite Significant Lapses in Process Safety, Outdated Operating Procedures http://www.csb.gov/newsroom/detail.aspx?nid=238&SID=0&pg=3%2f%2f%2f%2f'%2c%2f%2f%2f'%2c%2f%2f'%2c%2f'%2c'%2c&print=y

4. What is in a Procedure • Usually include • Pre- or entry conditions • Steps • Actions, decisions…. • Specification of order of execution for none, some or all of the steps • Warnings and cautions • Post-conditions • « Configuration management » Checklists Operating manuals « Cardex » Procedures Protocols « A set of instructions to assist specified users in carrying out specified task in a specified context of use to achieve specified results »

5. What procedures can do for you • For the individual  • Support decision-making in stressful situations • Prevent or mitigate memory lapses • Document what was done • For the organization • Train new staff • Refresh experienced staff on infrequent tasks • Support continuity planning • Manage events

6. Frequent Issues Using them Producing them Complying with them CAP 716 AVIATION MAINTENANCE HUMAN FACTORS

7. Tips • Strategy: define • Purpose of the procedures • Help the organization achieve its purpose OR satisfy some external body OR both OR… • Compliance policy (including how to handle deviations) • E.g., Procedures shall be used as written and no deviation shall be tolerated… OR…. Procedures as guides… OR…several classes… • How compliance will be assessed • How the procedures will be maintained

8. Tips IOWA DEPARTMENT OF PUBLIC HEALTH - INDUSTRIAL RADIOGRAPHY EXPOSURE DEVICES REGULATORY GUIDE http://www.idph.state.ia.us/eh/common/pdf/radiological_health/industrialrad99.PDF Common mistake • Writing good proceduresistough but getseasierwith a bit of practice • Experts at the job are not necessarilygreatprocedurewriters

9. Tips • Tactics • Specify for whomyouwrite (or review) procedures and the purpose of the procedure • Differentiatebetween « conceptual » and « procedural » information AND organizebothadequately • The processis: analyze the needs and constraints, produce a first version, assess, and correct => repeat as required => thendeploy and train • Writer’s guide • Process for authoring, reviewing and authorizing • Authorizedwords • Fonts, styles, headings • Syntax • Principles and rules • Templates for pages and for procedures

10. Tips Sizesshouldbecalculated and measured on paper – avoidrelying on « points » Adapted from: http://www.visualexpert.com/Resources/olderdrivers.html, 20 years old 60 years old 75 years old • Ensure the textislegible • For text, avoidcolorlike the plague • Typically, youshouldspecify font size and « type » (e.g., Times Roman). Actual size depends on: • Distance of use • Environment of use • Characteristics of users (e.g., age…) • To besafe, maywant to specifylargersizes

11. Tips • Writingindividualsteps • Keepindividualsteps simple • In general: short words in short sentences work best • One instruction by step • Break down complexstepsintosimpler, successive steps • Avoidnegative in conditionalslike a major plague • Tryit: • IF pressure in Tank 23 is NOT greaterthan 145 KPa, THEN Observe • Use right format • steps for instructions, warnings for warnings, and notes for notes! • Warnings before a step, not after…. • Check boxes or room for initials if eachstepis to beconfirmed

12. Tips • Use the right vocabulary • Always the same word for the same thing • Few words => fewer mistakes • Words familiar to the staff AND correct for the task • Short words => easier and faster to read • Standardized rules for abreviations • Use same abreviations throughout

13. Tips • Rules for numbers • Usually, numeral for physical measures and for 11 items or more • Use separations = 277 733 rather than 2877733 • Same form • Only the precision required and available • Include units of measure, where applicable • Avoid calculations like the plague • If absolutely required, provide a calculation aid and enforce its use • Use ranges => 17 – 23 C rather than 20 ± 3 C

14. Tips Training Level of Detail For the Procedure Familiarity • Level of detail • Making the procedureoverlydetaileddoes not help any • Revisionsoften tend to increase the thickness of the procedurewhiledecreasingitsusefulness…

15. Tips Common mistake Sequence not forced: unorderedlist Sequenceforced: orderedlist Do…… Do…. Do…. Do…… Do…. Do…. • Do…… • Do…. • Do…. • Use good syntax • Active form rather than passive • Avoid inversions • Longer to read • Higher error rate • In a step, force sequences only when absolutely necessary

16. Tips Warning? • Putting it all together • Review and critique • Identify improvements • Beware of limits of knowledge on application

17. Tips • Some unanswered questions • Pictures? No pictures? • Prose or flowcharts? • Enough, too much, not enough information? • Solution: combine training and procedure content, and take into account user knowledge before specifying the level of details • Standards • Some process / attribute standards exist for some types of user documentation

18. Tips Common mystery • A few cheap tricks… • The value of pre-testing… • People willoftenspend more time explainingwhytheydon’tthinkitisnecessary to validate, walkdown or otherwise test the procedurethanitwouldtake to actually do it… • Testing or validating a proceduresolely by talking about itaround a table is a weakmethod • You will not getit right the first time • If you do, sendyour résumé… • Proceduresneed to bemaintained • A desktop reviewbased on the rules and principlespresentedherewillreveal lots • Compliancewithwriter’s guide or good practices • Eliminatingwordswithoutloosing the meaning • Procedural vs conceptualknowledge • ...

19. Case Study • Abnormal Situation Management (ASM)

20. Case Study • ASM

21. Case Study • ASM: a procedure-driven approach

22. Resources • Wieringa, D., Moore, C., Barnes, V., PROCEDURE WRITING: PRINCIPLES AND PRACTICES, 1998. 2nd ed. Columbus, OH: Battelle Press. [ISBN 1-57477-052-7. 243 pages, including index • For the ASM case study: White Paper - Human Performance and Abnormal Situation Management • Paper copies are available • Can be downloaded from • www.shumac.qc.ca or • www.shumac.com.ar

23. Conclusion • Procedures are more than « words on paper » • They are not a necessary evil… • they will help us to …. prevent a situation… respond to a situation… train staff… document our work… • One of the most cost-effective way to improve operations and safety • And, best of all, they can be developed and used by mere mortals

24. Procedures in an Organization Adapted from: TP 13739 E Introduction to Safety Management Systems, Transport Canada • The 4 Ps of Safety Management • Management Philosophy • Specifying how safety will be achieved through People • What management wants people to do (Procedures) to execute the policy • Practice - What really happens on the job