David Learmount/LONDON Julian Moxon/PARIS Paul Phelan/CAIRNS
In 1998, the Australian Defence Force, (ADF), which has about 450 aircraft, had a flying accident-free year throughout its services for the first time. That, however, according to experience worldwide, is extraordinary.
The ADF's exceptional year follows closely on the introduction of measures to make all three services in the combined force more of a team in the safety arena, although it is too early to say whether these have played their part in producing a zero-accident 1998. Building safety teamwork in variety of ways, however, seems to be a priority for air forces today.
The French air force states bluntly what it - and air forces all over the world - see as the everyday reality. Military operations, even in peacetime, are inherently risky, so there is little chance of the accident rate coming down to zero over any extended period. The aim is to keep the risk as low as possible without compromising military effectiveness, says the French air force's office of flight safety. The air force says that, since it set up formal accident reduction programmes during the 1970s, the accident rate has reduced by at least 30%. "We're down to between three and five fatal accidents a year," the flight safety office says, adding: "We're not sure we can get it much below that, but we're still trying."
Today, most of the French air force's effort is directed at overcoming human factors problems, which are causal in 70% of all accidents. Recently instituted confidential and anonymous reporting systems have been working "extremely well", the French service says.
Among international flight safety methods today, the blame-free confidential reporting system seems potentially to be the most fertile of flight safety initiatives, particularly in the discipline-orientated - and therefore normally blame-orientated - military culture. The UK's Royal Air Force has reported growing success using a radically new concept in the military environment: the human factors open reporting system (HFOR). The system has so impressed the aerospace world - both civil and military - that this year the industry leaders on the Aerospace Industry Awards panel awarded the RAF Inspectorate of Flight Safety the Flight International Training and Safety award.
The HFOR concept is based on the well established "iceberg principle" that accidents almost always reveal faults or mistakes somewhere in the total system, but that most system faults have caused many unrecognised incidents before they trigger the accident that brings them to light. If the faults, including human mistakes, could be recognised and corrected, the risk of potential accidents could be reduced.
HFOR encourages individuals to report "honest mistakes", with the promise that no blame will attach to the person who makes them. RAF Inspector of Flight Safety Air Cdre Lloyd Doble explains: "We have the Condor and Murphy confidential systems. These are well established and have run for years, but, of course, we wanted to go beyond that. We are all human. We all make mistakes. So [HFOR] was an initiative some three years ago to explore the mechanism of human failings. We had support from the highest level for the development of our open and honest reporting culture."
The system was not immediately and universally accepted, Doble admits. He says: "We are really getting through now to the aircrew community. Virtually daily now I am getting aircrew reports which are proving useful. But we have been less successful among our maintenance engineers." Engineering is, if anything, more highly regulated than flying in its system of checks and multiple-signature clearances, Doble points out, so it is inherently more of a team process.
This can mean that an individual's declaration of a mistake which is not detected may imply failure by others in the team. To counter this reluctance, says Doble, "we are going out and holding seminars for all the [officers commanding engineering wings]. We have a road show, and we are also in at the training schools, so that the youngsters coming in right now are being educated in the overall philosophy of our open and honest reporting culture."
The issue is that of winning people's trust, Doble says. Not only trust that those who file reports will not face disciplinary action, but that the declaration of an error will not damage their careers. In practise, reveals Doble, "those who have the courage to report their honest mistakes are becoming well respected by their peers for standing up and being counted, and we are getting a number of significant reports which I am convinced, in my own mind, are leading to the prevention of accidents. These are errors that they have made, perhaps, through training for operations, perhaps involving specific highly complex manoeuvres where they have made a mistake, and there is a trap there for everyone else. The fact that they have advertised it means that we can draw the right lessons."
The deputy director of flying safety for Australia's ADF, Wg Cdr Ian Warburton, agrees, stating that a blame-free reporting culture has played a major part in improving its safety culture "immeasurably" over the past 10 years. "People are tending more to report normal human errors, and instead of [being disciplined] they've been congratulated.
Doble thinks that "this is one of the most exciting initiatives in the flight safety world", and spoke in detail about it last month with US Air Force head of flight safety Maj Gen Rusty Gideon. "I know that he and others are greatly attracted by the initiative," reveals Doble, acknowledging that the level of difficulty of introducing a system like HFOR, which was not easy to do in the RAF, varies with the service culture into which is is introduced.
Combining resources
Since the RAF Inspector of Flight Safety holds the permanent chairmanship of the Air Forces Flight Safety Committee, Europe, Doble is well placed to present ideas to influential safety chiefs. Sharing information, however, does not stop at Europe. "We are plugged in to air forces around the world," says Doble, adding: "We are able to judge what we consider to be best practice. We are always on the lookout for new initiatives and, of course, we can reciprocate by explaining what we are doing, what has been successful and where we have made mistakes."
The three Australian services within the ADF, each of which had its own safety system, have adopted a new means of co-ordinating safety, Warburton says. Since 1997, the Directorate of Flying Safety (DFS) has been an ADF organisation covering all three services. Before this, for example, the Royal Australian Navy and the Army would each be looking after safety policy in its own fleet of Eurocopter Squirrels, although both were relatively small fleets. "We've now said the organisation within the DFS will be divided not along service lines, but aircraft lines [which] means we only have one desk officer for all ADF Squirrels," Warburton says, pointing out that this policy extends to all types common to more than one service.
Teamwork, through cross-service co-operation and a new openness in sharing human factors information, seems to be a vital way forward for today's military flight safety.
Source: Flight International
