SMS Owners

 SMS Owners

By OffRoadPilots

Two owners of a safety management system (SMS) are flight operations and airport operations. In their own area of operations, they are the hazard owners and hands-on process control managers. With the implementation of SMS operational safety was moved away from the safety manager’s office and to areas of operations where they belong. In addition to social media opinions, there are still aviation managers who believe that a safety manger’s role is to keep everyone safe, it is their role to establish acceptable risk levels, and that it their role to overrule operations mangers and airport mangers if a safety manager decided a decision to be unsafe.

A safety management system is about processes and daily work practices. The final authority for risk acceptance is the accountable executive (AE). It is important to know that an SMS is not the magic wand that prevents future accidents from happening but is a tool to lay out the path for success. The first task on this path is to develop work practices with an output that conforms to regulatory requirements. One daily task may combine compliance with several compliance requirements. Another task is to develop work practices that conforms to safety in operations. Safety in operations is more than preventing accidents, it is also reliability of operational tasks. This could be reliability of the daily inspection at an airport, reliability of developing aside operations plans, or reliability to communicate non-standard airside work practices and decisions in a timely manner to the SMS manager and AE. A healthy SMS is not about prohibition and restraints but is about communication and accountability.

Taking ownership at work is to take initiative and responsibility for success or failure of SMS enterprise. SMS teams needs players willing to step up and take ownership of mistakes or challenges, as opposed to wanting to blame others for any issues. In practice, taking ownership within an SMS system means being proactive, solution-oriented, accountable, and committed to continuous improvement. Anyone who takes on ownership at work are prepared and ready to take on whatever challenges come their way. They have strong problem-solving skills and anticipate problems to prevent them before they happen, rather than waiting for things to go wrong and scrambling to fix them. They are also looking for ways to improve things. They're the ones who come up with new ideas and find creative solutions to complex problems. Workers who take ownership also take responsibility for their own actions. They own their mistakes and take responsibility for their successes. SMS team members don't shy away from accountability, they embrace it. Ownership is key to having a high-performing team. When a worker buys into the SMS, and its vision and they feel that they have a stake in its success, they are more likely to be engaged in their work.

There is a difference between a worker taking initiatives and a worker accepting a risk or developing risk controls outside of their area of responsibility. Accepting or rejecting a risk is the role of an accountable executive. A worker’s initiative is not to make changes that affects operations, but to take initiatives to communicate suggestion, hazards or options with managers and the accountable executive when issues arise. It is also to make initiatives and take actions when there is an apparent threat to personnel, equipment, or structures. Such action could be to initiate a missed approach without being instructed by ATC.

Unknowingly to the flight crew their airliner on final approach was lined up on the taxiway with several sequenced aircraft for departure. The flight crew observed lights, that they thought were aircraft on the runway. They made an inquiry to the tower who informed them that the runway was clear. Within an SMS world, a pilot is allowed to conduct a missed approach even if they are wrong in their assessment of an apparent danger. An airside ground vehicle with a clearance to cross a runway, may decline the clearance if there is something they have concerns about, even if their concern was not an actual issue. Taking initiatives within an SMS enterprise is to take initiative without consideration for punitive actions, or to take initiative for actions that later was shown not to be necessary.

The safety management system was sold as the solution for airlines and airports to identify risks before they become bigger problems, and that the regulations was required as an extra layer of protection to help save lives. When the safety card is played, i.e. that the regulation will “save lives”, is a red flag since their safety statement is without merit for an effective safety management system. It sounds good that SMS will save lives, but accidents have still happened after SMS was implemented. SMS was, and still is, sold as “saving lives” tool. If this statement is true that an SMS actually saves lives, it is not the fault of an SMS operator when there are occurrences.

In 2011 an SMS enterprise crashed an airliner. In this instance their SMS did not prevent the accident from happening. The aircraft was cleared to descend out of controlled airspace for an approach. The crew initiated the pre-descent checklist and the FO contacted the terminal controller and provided an ETA, with their intentions to conduct a Runway 35 approach. The crew then contacted tower controller, who advised them of the altimeter setting, winds, and instructed them to report 10 nm final for Runway 35. The crew asked tower controller for a runway condition report and was advised that the runway was a little wet and that no aircraft had used it during the morning. The crew initiated the in-range checklist, they configured the aircraft for approach and landing, and initiated the landing checklist. At 10 NM final for Runway 35 the captain called for the gear to be lowered and for flaps 15. At this point in the approach, the crew had a lengthy discussion about aircraft navigation. The aircraft flew a controlled flight into terrain about 1 NM east of the runway.

Another incident that an SMS was unable to prevent, was a taxiway overfly at a busy airport. An aircraft was cleared to land on runway 28R but instead lined up with parallel taxiway. Four air carrier airplanes (a Boeing 787, an Airbus A340, another Boeing 787, and a Boeing 737) were on the taxiway sequenced for takeoff. On approach the flight crew contacted ATC with a concern that there were aircraft lights on RWY 28R, and ATC informed them that the runway was clear. The flight crew of one of the sequenced aircraft then informed ATC that the approaching aircraft was “on the taxiway”. The tower controller instructed the incident flight crew to go-around. The approaching airplane descended to an altitude of 100 ft above ground level and overflew the first airplane on the taxiway continued its descent to 60 ft overflying the second airplane on the taxiway before starting to climb.

The flight crewmembers had recent experience flying into this airport at night and were likely expecting the airport to be in its usual configuration, but on the night of the incident, parallel runway 28L was scheduled to be closed. The captain later stated that, as the airplane approached the airport, he thought that he saw runway lights for runway 28L and thus believed that runway 28R was runway 28L and that taxiway C was runway 28R. The captain asked the first officer to contact the controller to confirm that the runway was clear, at which time the first officer looked up. By that point, the airplane was lined up with taxiway C, but the first officer presumed that the airplane was aligned with runway 28R due, in part, to his expectation that the captain would align the airplane with the intended landing runway. Neither flight crewmember recognized that the airplane was not aligned with the intended landing runway until the airplane was over the airport surface, at which time the flight crew initiated a low-altitude go-around.

Both incident airlines were operating with a regulatory conforming safety management system, but their SMS were unable to prevent the incidents. There are several reasons, or justifications, for these occurrences, but one fundamental SMS principle lost in the equation, was for the rightful owner to take ownership of their SMS and do something about it. In the second example, both ATC and one of the sequenced flight crew took ownership and prevented a disastrous outcome. SMS ownership is what made a difference, and SMS ownership is what prevented a major accident. SMS in itself did not prevent any of these occurrences, but taking ownership of progressing events would have made a different outcome.

A successful SMS is built on a foundation that personnel accept their roles as hazard owners. An SMS that does not identify its rightful hazard owners is an ineffective tool. A captain is the final authority and decisionmaker of a flight and this principle must not change. Everyone else need to accept that the captain is the final authority, and that other flight crew members have other ownership roles.

An accountable executive is the owner of regulatory compliance and safety in operations. However, an AE is not the owner of an SMS manager, and when they reject a recommendation from an SMS manger, the AE must take ownership and develop their own action to implement in their safety management system. Just as a CEO of a corporation may reject a recommendation made by an accountant or lawyer, a CEO, or AE may also reject a recommendation by an SMS manger and design their own action plan. Ownership is different than authority. Authority is to make decisions on behalf of someone else, while ownership is applied to a floating task for a person to pick up. Ownership is not an action that someone else need to do but is an action that I need to do at this moment.

An accountable executive is the owner of all hazards, director of flight operations is the owner of all flight hazards, director of maintenance is the owner of all maintenance hazards. In addition to these SMS owners, each person within these departments are the owners of hazards as they are applicable to their job performance expectations.

OffRoadPilots