Does Safety & Risk Management need to be Complicated?
With Engineer’s Australia recent call-out on socials for "I Am An Engineer" stories, I was discussing career accomplishments with a team member (non-Engineer) and we were struck by how risk and safety need not be complicated – that the business of risk and safety, especially in assessment terms has been over-complicated.
Two such career accomplishments that really brought this home was my due diligence engineering work on:
- Gateway Bridge in Brisbane
Our recommendation was rather than implement a complicated IT information system on the bridge for traffic hazards associated with wind, to install a windsock or flag and let the wind literally show its strength and direction in real time. A simple but effective control that ensures no misinformation. - Victorian Regional Rail Level Crossings
R2A assessed every rail level crossing in the four regional fast rail corridors in Victoria for the requirements to operate faster running trains. The simple conclusion, that I know saved countless lives, was to recommend closing level crossings where possible or provide active crossings (bells and flashing lights) rather than passive level crossings.
However, some risk and safety issues are not as simple, like women’s PPE.
The simple solution, to date, has been for women to wear downsized men’s PPE and workwear. But we know this is not the safest solution because women’s body shapes are completely different to men.
My work with Apto PPE has been about designing workwear from a due diligence engineering perspective. This amounted to the need to design from a clean slate (pattern, should I say!) -- designing for women’s body shapes from the outset and not tweaking men's designs.
Not everyone does this in the workwear sector, but as an engineer, I understand the importance of solving problems effectively and So Far As Is Reasonably Practicable (SFAIRP).
By applying the SFAIRP principle, you are really asking the question, if I was in the same position, how would I expect to be treated and what controls would I expect to be in place, which is usually not a complicated question.
And, maybe, my biggest career accomplishment will be the legacy work with R2A and Apto PPE in making a difference to how people think about and conduct safety and due diligence in society.
Find out more about Apto PPE, head to aptoppe.com.au
To speak with Gaye about due diligence and/or Apto PPE, head to the contact page.
The Laws of Man vs The Laws of Nature & Safety Due Diligence
One of the odder confusions that R2A happens upon is the proposition that the laws of man are always paramount in all circumstances. It seems to occur most often with persons who work exclusively in the financial sector.
From an engineering perspective, this is just plain wrong.
When dealing with the natural material spacetime universe, the laws of nature are always superior.
After some cogitation, we suspect that this confusion results from the substance of which the financial parties contend, specifically, money.
Sometime ago, over lunch with a banker out of Hong Kong, it was pointed out by R2A that money wasn’t real. The banker expressed surprise and asked what we meant by that. Our reply was that money does not exist in a state of nature. For example, it does not grow on trees. It is a human construct which prosperous societies apparently need to succeed, but of itself, is not directly subject to the laws of nature.
The banker’s response was to ask us not to mention this to anyone.
From this, we conclude that for financial people at least, compliance with legislation and regulations made under it that directly applies to the concept and use of money does demonstrate financial due diligence since the laws of nature are simply not relevant.
However, in the case of safety due diligence, just complying with the laws of man and ignoring the laws of nature will just end in disaster after disaster since the laws of nature are immutable.
To demonstrate safety due diligence requires that the laws of nature are understood and managed in a way that satisfies the laws of man – in that order.
Remember that, legally, safety risk arises because of insufficient, inadequate or failed precautions, not because something is intrinsically hazardous.
For example, flying in a jet aircraft or getting into low earth orbit is intrinsically hazardous, but with enough precautions, it’s fine.
Leave a critical precaution out or let one fail and you will crash and burn. It’s inevitable.
Much the same has been happening with the Covid-19 crisis as discussed in our blog a few months ago (read article here).
Going directly to a political fix without understanding the science is going to hurt. Getting both right is necessary, but it has to be in the right sequence.
Overall, it’s always been no contest – the laws of nature have always trumped the laws of man, except when dealing with non-natural human constructs like money, debt and suchlike over which the laws of nature have no direct control.
Postscript: Risk, as a concept, has many of the same problems as money. It’s a human judgement about what might happen.
For example, consider the use of the popularly used heat map shown below.
Most users spot-the-dot to characterise the risk associated with a particular issue. But technically it is necessary to know the actual shape of the risk curve for that hazard (the wriggly line going from left to right) which is difficult for real spacetime hazards let alone human judgements of no-material constructs like money.
Strictly it’s also necessary to integrate the area under the risk curve (shown as the darkened area), which is never done. This just goes to show how flexible the concept of risk can be.
The importance of Safety Due Diligence: Keeping directors out of jail
Coroner's Finding into Dreamworld Thunder River Rapids
The death of four young people at Dreamworld in the Thunder River Rapids in October 2016 has brought the prospect of criminal prosecution of Directors for safety failures to the fore, or, as we say, Safety Due Diligence.
Press reports have indicated that the Queensland Government has accepted the Coroner's findings and referred the matter to the independent Work Health and Safety Prosecutor to decide whether action would be taken against Ardent, the owners of Dreamworld. Presumably such action would likely be criminal proceedings under Section 31 Reckless conduct—category 1 of the Qld WHS Act 2011.
Reckless Category 1 offences are usually summarised as ‘knew or made or let it happen’. Simply put, it asks:
Did the Board (especially the Chairman and Managing Director of the day) know of the issue and ensure that all reasonably practicable precautions were in place, or had they downplayed it and relied on ‘luck’?
Based on press reports, it seems as though the ride’s safety issue was a known problem and despite the expressed concerns of employees, it was basically ignored or, at least, not taken seriously.
Criminal offences must be proved ‘beyond reasonable doubt’ which is a very robust test.
To give a feeling for what it entails, the prosecution of a General Manager in ACT in 2015[1] provides insight.
In this case the Director of Public Prosecutions acted on behalf of Worksafe ACT. Essentially, Mr Munir AL-Hasani was charged as an Officer (General Manager) of Kenoss Constructions, a small family owned (husband and wife directors) road construction company. over the death of a contractor.
For the most part, the charges were proved. However, during the hearing it became clear that despite the title of general manager, Mr AL-Hasani did not have the right to hire or fire and could not commit corporate funds. Accordingly, Magistrate Walker was not satisfied that Mr AL-Hasani’s role, beyond reasonable doubt, rose to that of an Officer of the company and so the charge was dismissed.
Such a governance detail seems unlikely to apply to the Dreamworld case. The Chairman and Managing Director would appear to be Officers for the purposes of the legislation.
According to the Coroner, the issue was known to the organisation and some precautions, but not all reasonably practical precautions, were established.
From R2A’s perspective, this would seem to be a form of failure based on the well-known ‘Rumsfeld manoeuvre’ or an ‘unknown known’. That is, known to the organisation but unappreciated by decision makers.
Can this be proved beyond reasonable doubt in the Dreamworld case? We don’t know, but we suspect that it will be a close-run thing.
At R2A we had anticipated that the rise of such WHS safety imperatives was likely to cause the appointment of technologically savvy Directors; at least in high tech industries subject to high consequence-low likelihood events and in those jurisdictions where proven failure was criminal (initially Qld and ACT). But since then most other Australian jurisdictions have also adopted criminal manslaughter provisions.
All in all, what happens in Queensland next will certainly have the undivided attention of Directors and their safety due diligence processes. As it should.
If you'd like to learn more about R2A's Safety Due Diligence approach, you may be interested in watching our Safety Due Diligence webinar recording.
[1]Brett McKie v Munir AL-Hasani & Kenoss Contractors Pty Ltd (In Liq).Industrial Court of the Australian Capital Territory before her Honour IndustrialMagistrate Walker.
Coronavirus Pandemic & Safety Due Diligence
A fabulous array of material has emerged on government websites regarding the Coronavirus (COVID-19). Worksafe Australia has published an interesting article on the connection to WHS legislation. This emphasises that employers have a duty of care to eliminate or minimise risk, so far as is reasonably practicable (SFAIRP).
There then follows numerous precautions described in enormous and voluminous detail. In an attempt to cut to the chase, R2A decided to apply our usual precautionary approach to the whole thing to see if we clarify what all this means.
So far as we can tell, the core difficulty with the new coronavirus is that it is very, very contagious. Much more so than ordinary flu.
This means it will escalate with startling speed and easily overwhelm our medical resources unless stringent measures to reduce the infection rate are implemented.
To calculate the infection rate, a probabilistic epidemiological model appears to be being used, conceptually shown above. That is, all the individual transmission pathways may not be fully understood, but an overall probabilistic transmissivity model can be created.
From a statistical viewpoint, if enough people are involved, the predictions should be quite robust and is presumably the basis of our governments’ concerns.
Causal workplace infection pathway single line threat barrier diagram
Following the hierarchy of controls, the threat-barrier diagram above identifies the elimination option (a vaccine), the precautions such as isolation and infection control prior to the loss of control point and then the mitigation options including hospitalisation which act after the loss of control point.
However, from the perspective of any single infection, there will likely be a single causal chain of events, which can be interrupted in various ways, particularly following the hierarchy of controls enshrined in the WHS legislation.
Such an understanding enables SFAIRP to be demonstrated. There would be different sequences for different paths; family, hospitals, workplace, team sports and the like.
From an employer /employee perspective, we think the single line threat-barrier diagram shown above is a reasonable first cut.
If you'd like to learn more about our Safety Due Diligence approach, read our White Paper here.
Australia’s Bushfires from a Due Diligence Perspective
Like you, we have been devastated by the recent bushfire events in Victoria, NSW and Queensland. We hope you have been able to stay safe and have not been directly affected. Richard and I have been reflecting on bushfires in history and if there are any key take away messages from a due diligence perspective.
Richard’s involvement with bushfire risk reviews commenced in the 1980s following the Ash Wednesday fires in Victoria. As part of a research project, Richard completed a threat and vulnerability assessment to see if there were any precautions that were missing from (then) current practices.
The outcome was that there were significant risk reduction benefits associated with improved town planning. This required the placement of huge fire breaks, such as golf courses and potato fields to the north and west of the town.
From the CFA website:
A change in wind direction is one of the most dangerous influences on fire behaviour. Many people who die in bushfires get caught during or after a wind change.
In Victoria, hot, dry winds typically come from the north and northwest and are often followed by a southwest wind change. In this situation the side of the fire can quickly become a much larger fire front.
Richard was then a member of the Powerline Bushfire Safety Taskforce that followed the Black Saturday fires in 2009.
My involvement continues on the Powerline Bushfire Safety Committee.
One of the key findings of the Black Saturday Royal Commission was that the majority of the fires were started by electrical assets and significantly contributed to the huge number of fatalities.
I am very proud to be involved in the roll out of REFCLs (Rapid Earth Fault Current Limiter) in Victoria, and their contribution to improving bushfire safety. Data from a total fire ban day in November 2019, revealed that REFCLs on the electrical network are working to reduce the number of fire starts from electrical assets.
Although bushfires of this magnitude were a new occurrence for NSW in 2019/20, there are many learnings from past Victorian fires that can be applied.
And, it is interesting to compare the community’s response to cyclones in the north of Australia to community responses in bushfire prone areas.
Buildings in cyclone prone areas are subject to more stringent building codes and during cyclone warning periods. It’s typically practice for people living in those areas to go home and prepare their house. All loose items of furniture are removed or tied down, shutters are closed, and communities are generally shutdown.
The same does not occur for bushfires prone areas.
As due diligence engineers we ask the question is there anything more that can be done?
The focus should always be on precautions rather than mitigations and we should certainly learn from past experiences.
In light of these recent events, we have revisited our Safety Due Diligence White Paper and Powerline Bushfire Safety Taskforce Case Study. We hope you find them interesting and insightful.
Energy Safety Report Released
The Release of the Final Report and Government Response - Review of Victoria's Electricity and Gas Network Safety Framework has occurred and is available at https://engage.vic.gov.au/electricity-network-safety-review.R2A is quoted a number of times in the report.Two of the key recommendations, supported in principle by the government, are:
34 All energy safety legislation should be consolidated in a single new energy safety Act, replacing the Gas Safety Act 1997, Electricity Safety Act 1998, those elements of the Pipelines Act 2005 that relate to safety, and the Energy Safe Victoria Act 2005.35 The general safety duties within the new consolidated energy safety legislation should be based around a consistent application of the principle that risks should be reduced so far as is “reasonably practicable” aligning with the definition adopted in the Occupational Health and Safety Act 2004.
Recommendation 35 does not sit well with a significant number of Australian Standards which continue to use an ALARP (as low as reasonably practicable) approach, supported by a target or tolerable level of risk and safety instead of the ‘so far as is reasonably practicable’ approach of the 2004 Victoria OHS Act and the model WHS legislation adopted in almost all other Australian jurisdictions, and in New Zealand.Such standards particularly include AS2885 (the pipeline standard), AS5577 (electricity network safety), AS (IEC) 61508 (functional safety) and its derivatives.R2A has previously commented on this issue. We (also) regularly have had to overturn the ALARP approach in these standards based on relevant legal advice.I'll be presenting the basis for this need to the Chemeca 2018 conference in Queenstown on 2nd October in a session entitled: Gas Pipelines and the Changing Face of Australian Energy Regulation.