# Presentation: 089363

## Management Council Meeting
 ISMS Assessment Follow-Up
July 14, 2005

-  ISMS Assessment Follow-Up
- July 14, 2005

## The task:

-  Determine *why *the ISMS Assessment findings existed to begin with and if wider-reaching corrective actions are needed to address potential management system deficiencies.

## DOE’s FY 2004 Performance Evaluation of BSA

- 	**Executive Summary**
- 	...The Laboratory’s performance in Safety & Health was rated marginal.  ...the Safety Performance Progress Assessment states that BSA selected some of the “low lying fruit,” choosing not to select the more difficult tasks such as culture change, incident investigation, corrective actions, skill of the craft, etc.  BSA’s performance under OSHA Reportable Injury Management was rated Unsatisfactory. BSA has been made aware of the need to improve its injury/illness statistics over the past several years, but progress has been slow.

## The process:

_**Day 1**_** (7/12/05) **- Safety and Quality Management Team analyzed Multidisciplinary Task Force (2003), Category “R” Recurring Occurrences (May 04), ISMS Assessment (August 04), Safety Culture Benchmark Review (October 04).
_**Day 2**_** (7/13/05) -** ESH&Q Coordinators & significant contributors reflected on and critiqued day 1 work.
_**Day 3**_** (7/14/05) -** Management Council, ALDs, Dept Chairs/Division Managers meeting

## Why did the findings exist in the first place?

- Competing Priorities

- Decisions to reallocate funds:
- EMS, LDRD, etc.

- Increased enforced
- expectations

- Performance

- Funding

## Everyone is frustrated:

- Anger/denial when funds are decreased or redirected.
- Anger/denial when expectations are enforced.
- Anger/denial when enforced expectations increase.
- Predictable responses when resources are constrained and expectations increase: ignore it, fight it, can’t afford it.

## But, we still endeavor to improve:

- Problems

- Corrective
- Actions

- Opt Out /
- Minimize

## Why Opt Out / Minimize?

- May consider corrective actions to be too complex (developed without adequate input).
- Actual or perceived lack of funding.
- Implementation will interfere with other scheduled activities.
- Politics.
- Over-confidence.
- Entitlement.

## Opt Out Behaviors

- Don’t show up when an issue is being discussed.
- Don’t question accuracy of reports at the appropriate time.
- Ignore what we don’t like.
- Get permission not to participate.
- Claim that we are unique – it should not apply to us.

## Minimizing Behaviors

- Try to get by with doing  a portion of the task or doing the parts we like the most, or can afford.
- Make it all look as good as possible.
- Some groups look for ways to push the actual work out into other organizations.

## So why did ISMS findings exist to begin with?

- Consequences of earlier choices.
- “Ignore it, Fight it, Can’t afford it” response to increasing enforced expectations.
- Opt Out /Minimize

*None of the ISMS Assessment*
*findings were a surprise to anyone in the field*
*who reviewed them.*

## Are wider reaching corrective actions needed?  Yes.  Five areas of “high hanging fruit” to harvest.

- Skill of the worker.
- Hoisting and Rigging
- Enhance the culture of self-critique
- Configuration Management
- Workforce relations

## Skill of all levels of workers. 

- Clearly define what is meant by “skill of the worker” in operational terms – job specific.
- Incorporate our “skill of the worker” knowledge in our work planning and control system.
- Examine our approach to planning the low-risk, but infrequent, work.
- Examine ways to help focus attention while performing frequent tasks.
- Seek worker input and participation.
- No opt outs.

## Overhaul Hoisting and Rigging program

- Implement the corrective actions for Hoisting and Rigging identified in the response to the ISMS Assessment.
- No Opt Outs.  No minimizing.

## Enhance the culture of self-critique (open reporting)

- Some lab organizations feel they will be punished for self-critique.  Top management must assess this and compare lab practices to other organizational settings.
- Strengthen training for self-critique activities.
- Increase use of independent participants on accident investigations.
- Enhance reviews of accident investigations to identify common issues.

## Configuration management

- Five decades of cumulative issues.
- Need to verify that the lab has achieved control on electrical drawings.

## Improve the relationship between upper management and labor workforce.

- Multiple levels of workforce.
- Perception that some people are more equal than others.
- Issues with IBEW called out in ISMS Assessment.
- Need to work through some baggage.
- Need outside help to do this.

## Other important considerations:

- Does BNL have an adequate system for identifying, prioritizing, and budgeting for operational issues to meet its strategic objectives?
- Have changes in the structure for ESH&Q staff under BSA enhanced or diminished the Lab’s capacity for effectively managing S&H issues?