"It is easy to presume that the railway system will become safer and safer as it evolves. However, it can’t do that if our thinking about how to manage safety and develop our people doesn’t evolve with it" – Ann Mills, Head of Health and Safety Management, RSSB
In the previous ‘Over the horizon’ series, George Bearfield showed that rail is the safest form of land transport in the UK, and the safest of the largest EU railways. We owe our success to a complex recipe of safety management, operational learning, regulation, technology and the skills and dedication of our people at all levels.
It is easy to presume that the railway system will become safer and safer as it evolves. However, it can’t do that if our thinking about how to manage safety and develop our people doesn’t evolve with it. This article explores new thinking in safety and what it means for talent development. How can we evolve our development approaches to build on our strong safety pedigree and enhance our safety even further?
Currently, the rail industry relies heavily on procedural control to ensure safe operations. A primary focus of development and training for safety critical staff is around rule compliance. In many organisations, new recruits for safety critical roles are subjected to weeks of theory-based training, covering rules, instructions and technical information, before they experience the real context in which they will be working. Before people can work unsupervised they must demonstrate that they are ‘competent’ and a large part of our initial and ongoing development activity is geared towards a pass/fail competence judgement. There is a tendency to forget that competence is on a continuum with people at various stages along it such as novice, not yet competent, competent, proficient and expert.
Our railway is a complex socio-technical system. Complex systems are always capable of surprising those working with them. Although we do an admirable job of rule creation, there are already just too many states to comprehensively cover with rules. Thinking about the future rail system, this is even more so the case. There will be more complexity with more interlinked systems working together. There will be complex interfaces and interactions between existing and new systems. It isn’t hard to foresee that the role of many of our staff will change dramatically. The railway system of the future will require different skills from our workforce. There are likely to be fewer roles that require repetitive procedure following and more that require dynamic decision making, collaborating, working with data or providing a personalised service to customers. A seminal white paper on safety in air traffic control acknowledges the increasing difficulty of managing safety with rule compliance as the system complexity grows: ‘The consequences are that predictability is limited during both design and operation, and that it is impossible precisely to prescribe or even describe how work should be done.’
Since human performance cannot be completely prescribed, some degree of variability, flexibility or adaptivity is required for these future systems to work.
The new approach to safety
Recent safety literature has been calling for a new approach to safety, to supplement and strengthen our current approaches. It goes by several different names: Safety II, Safety Differently, New View of safety and Resilience Engineering, to name the main ones. There are two common themes. Firstly, recognition that work is safely and effectively achieved almost all the time. This is despite, and perhaps because of the variability of human performance. Hence, the next step in improving safety is to learn from successful work as much as from incidents and accidents. Secondly, the potential of people within the system to make the system more resilient is acknowledged and celebrated.
One key concept in this way of thinking is the difference between ‘work as imagined’ and ‘work as done’. Although associated with this new approach to safety, this is a concept that has been around since the middle of the last century (see Steven Shorrock's excellent article for a fuller explanation). ‘Work as imagined’ is how different layers of an organisation think work takes place. ‘Work as done’ is what people actually do. There are overlaps of course but ‘work as done’ occurs in the real context which is often not quite what was imagined. ‘Work as done’ responds to the reality of conflicting goals, degraded situations and social context. To meet these real demands, people in the system make compromises and create solutions. ‘Work as done’ includes the whole range of performance of the system, star performance, poor performance, different ways of doing things, good days and bad days and everything in between.
Safety differently, development differently
When we think about safety differently, we are inspired to think about development differently. When we design a training programme, assessment or competence standard, or even when we write an objective for someone we manage, we are thinking of ‘work as imagined’. This means we are missing an understanding of real work that could be invaluable to our development approach, now, and especially in the future. Equally, recognising that there will ALWAYS be a difference between ‘work as imagined’ and ‘work as done’ is critical.
How can we make the most of this difference rather than be caught out by it?
- Invest in manager skills to build a trusting relationship at all levels. Managers and supervisors need to be set free from the office and get onto the front line more to experience the context of real work and build their understanding of ‘work as done’. They are likely to discover a rich diversity of practice including innovative work arounds and difficulties they may not have been aware of. But, to do this successfully, they need to develop the right skills, and organisational policy and the other demands of their job must be enablers not barriers. For example, what should they do if they discover a routine violation that is critical to keeping the service running?
- Explore ‘work as done’ with an open mind. Seek to shift the focus away from ‘work as imagined’ towards the reality of ‘work as done’ as much as possible. Development activities need to include more real context and complexity. For example, this might include learning with a diverse group of people who are at different places on the competence continuum, who don’t communicate clearly or who don’t always strictly follow the rules. Development activities need to reflect realistic operational scenarios such as equipment failures, incomplete information and bad weather. Acknowledge the gap between work as imagined and work as done and include the hazards arising from this in training. This does not mean that violations should be tolerated, it is about being realistic and proportionate.
- Shift focus of development activities onto 'how to make things go right' not just 'how to avoid things going wrong'. Recognise the skill and flexibility that people are using within their work to get things done safely and effectively and work out how to pass those skills on to new recruits. It’s about learning how to make sensible and robust decisions in a world of changing circumstances, within the constraints that are important for safety. In this way, the conflict between safety and productivity, or safety and train performance, that is sometimes seen to exist disappears. ‘Making things go right’ means safe and effective.
- Harness the power of ‘experts’ to help develop newly competent people within the context of normal work. What is it that makes an expert better than someone who has only just learned the job? It is likely around their accumulated experience over time and how they have learnt from their own mistakes and successes in dealing with different situations. Consider opportunities to use the skills and experience of these experts to accelerate the development of less experienced colleagues.
- Recognise that workers may know more about what it takes for the system to work safety and efficiently than your trainers, and managers. Give more empowerment to staff at all levels to determine their own development needs and encourage them to take more responsibility in maintaining and developing their own competence. Let them say what they need to do their job even better and how they can best learn it.
The benefits of taking this approach will be hard to measure but a new approach is critical for us to successfully adapt to the future and compete with other transport modes as a service and as an employer. As the complexity of our rail system increases, it will simply become unwieldy to rely solely on rule compliance as one of our major safety defences. If we can be more flexible and take an approach inspired by new safety thinking, we will reap the benefits in terms of system resilience. We will learn about underlying weaknesses in our system that could lead to an accident. We will improve staff engagement and motivation. We will also learn more about how to continuously improve the effectiveness of our system from the experts operating it every day.