In 1977 KLM Flight 4805, a charter flight for Holland International Travel Group, was preparing for take-off after an unplanned stopover at nearby Tenerife Island. The charter flight, which initially came from Amsterdam Airport, was aiming for the destination of warm beaches at the Gran Canarias. On board the flight were 14 crew members and 235 passengers taking advantage of the early spring weather. The cockpit crew consisted of Captain Jacob Veldhuyzen van Zanten, First Officer Klaas Meurs, and Flight Engineer Willem Schreuder. Van Zanten was seen as an excellent pilot. He had over 11.000 flight hours under his belt and was KLM’s chief flight instructor. Captain van Zanten was highly trusted among his team and regarded as the gold standard in aviation practices.
Unfortunately, neither van Zanten, his crew, or the 235 anticipating passengers reached their destination of Gran Canaria. Instead, at take-off, KLM Flight 4805 ran straight into Pan Am Flight 1736 which was hidden in the fog on the active runway. The only survivors were the 61 people in the front section of the Pan Am aircraft. The Tenerife Airport Disaster shook the world and led to a revolution in aviation safety practices that we now know as Crew Resource Management (CRM). Not surprisingly, by the 1990’s CRM had become a global standard in the aviation industry.
Today, CRM is one of the most widely applied techniques for providing team training to operations personnel in high-risk industries. Through focus on non-technical skills, such as leadership, teamwork, communication, and other human factors, operations personnel are taught the skills needed for appropriate situational awareness, and the necessary behaviour to avoid accidents. CRM operates through the understanding that humans have evolved with complex social and psychological processes. By understanding these processes in the context of our job role and the psychological fallacies we are vulnerable to, we are better equipped to avoid, or react appropriately to, dangerous situations.
Ironically, the development of automation technology, which aims at replacing human error with predictable system processes, increases the need for CRM in the workplace. As operation personnel experience fewer incidents, they are more susceptible to complacency and less likely to react appropriately when a crisis arises. In fact, it is estimated that as much as 80% of all accidents are due to human error today. High hazard industries understand the consequences of human error, which is why they are willing to invest unreservedly in the tools that help their personnel with these emerging challenges. For example, between 2009 and 2013 Ohio State University Wexner Medical Center invested $3.557.000 million into CRM training and research. Like commercial aviation there are many other industries such as medical, energy or law enforcement where the cost of accidents; whether it’s a death from incorrect administration of medication, an oil spill due to an error in procedural protocols, or even a serious injury due to the improper use of a weapon, are all unacceptable.
While we still have much to learn about the many benefits of CRM, its effectiveness is clear. One meta-analysis conducted by Paul O’Conner highlights the relevance of CRM, illustrating that CRM training not only positively changes our attitude towards ensuring a safe environment, but also our knowledge and behaviour towards that goal. Such findings are not surprising. Coaching and mentoring, services we provide at CAVU International, are known to provide a significant positive effect on performance and goal-directed self-regulation. The majority of participants receiving CRM coaching typically find the training very useful, and expect a change in their behaviour as a result of it. This is greatly illustrated by the Ohio State University Wexner Medical Center, who discovered that the return of investment from their health system-wide CRM implementation was estimated to be between $9.1 million and $24.4 million. Or in the aviation industry, where a significant drop in accidents has been realized since the implementation of CRM.
Considering the positive benefits of implementing and using CRM in industries, such as the aviation and health industries, it is surprising to see that this has not yet become a standard practice in the oil and gas industry. However, this is slowly starting to change. After nearly two decades of research on CRM in the oil and gas industry, the International Association of Oil and Gas Producers (IOGP) developed guidelines for best practices on Well Operations Crew Resource Management (WOCRM) in 2014. In their initial report, Report 501 authored by Rhona Flin, Jill Wilkinson & Cakil Agnew the IGOP noted that:
“Until recent events, such as the blow outs experienced on the Macondo and Montara wells, the oil and gas industry had not fully recognised the importance of how psychological factors relating to perception and motivation can contribute to safe and efficient operations. It is now believed that a step-change improvement in operational safety and efficiency of well operations teams can be achieved through effective development and application of non-technical skills, also known as Crew Resource Management.”
Such a comment may well be an understatement. The oil and gas industry is characterised by hazardous conditions, complex roles and team structures, thus requiring a strong emphasis on process and personal safety. Here, the cost of an accident can be enormous. For example, the Macondo incident mentioned above has been estimated to cost $63.4 billions in legal fees and clean up alone. Investing in oil and gas exploration is an expensive business, and companies walk a thin line between large returns and bankruptcy. As recorded by Haynes and Boone, more than 500 oil and gas related bankruptcies have been filed in the North Americas alone since 2015. This is an industry where time is money, and any mistake can be expensive, if not fatal.
As such, Rhona Flin, a woman with decades of experience in Industrial Psychology and applied research in safety climates and non-technical skills, advised that any crew performing well operations should be trained in the function of the following six key factors:
- Situational Awareness
- Decision Making
- Performance Shaping Factors
At CAVU International we have adopted the advice and guidelines made by the IOGP and work towards making the oil industry a safer and more efficient workplace. In our experience, CRM works every time its applied. We’ll use one of our projects in Far East Russia as an example. This client had concerns prior to project start up because 70 out of 90 crew members were brand new to the project; only very few had worked on this rig before. There were cultural barriers, language barriers, and for many crew members’, their first time ever being in Russia. Many of the less experienced Russian team members had no previous exposure to a rigorous and robust safety culture and were unfamiliar with the client’s Safety Management Systems. Factoring in severe weather conditions in February, March and April, there were many obstacles to overcome. In this scenario, we developed Safe Start Seminars focusing on the key areas in CRM, as well as follow-up onsite coaching to bring the concepts to the work site. As a consequence, the team established a continuous improvement safety culture and achieved a hurt free, spill free, mobilization, rig up and demobilization with zero work related injuries and 296,464 man-hours without any operational down time or non-productive time.
Another example is through our ongoing collaboration with Port Houston. Here, we have helped establish a continuous improvement cycle ensuring that the Project Construction Management team could award 94% of the Capital Improvement Project target totalling $179 Million — a 68% improvement over 2018.
Lastly, through our own ongoing pursuit for excellence, we have combined our long standing experience in human performance with technical scenario-based simulation training programs. As part of this, we helped a major Norwegian contractor stimulate a high-performance culture optimizing the full capability of their state-of-the-art drilling systems. And the result? The North Sea campaign completed 150+ days ahead of the drill plan with zero incidents and drastically reduced non-productive time, flat time and down time.
Crew Resource Management helps teams overcome communication issues, poor decision-making, inadequate or undefined leadership, poor resource management, fatigue, and many other challenges. Its methods tackle universal human behaviours that can put your team at serious risk if not treated appropriately. These are behaviours that anyone, regardless of their position, experience or personality, can fall prey to. Ultimately, this is why CRM is becoming an accepted best practice across nearly every high-risk industry in the world.
Over the past decade, Fabian has immersed himself in the research and best practices of human performance and organizational development. Originally from Norway, his strong affinity for psychology and cultural studies led him to do a Masters in Organizational Psychology at Vrije University in the Netherlands. He is now dedicating his knowledge and skill to safety and performance in the Norwegian Energy Sector. With a solid international background, Fabian is fluent in both English and Norwegian, and is studied in the human factors that shape an organizational culture.