Regulator Safety Oversight Culture and Its Impact

Safety Culture Summit 2017 - Understanding Regulator Safety Culture

Regulator Safety Oversight Culture and its Impact

Today, regulators, like companies, are seeking to proactively strengthen the oil and gas safety system – sometimes through the establishment of regulatory requirements and sometimes through awareness and understanding of potential vulnerabilities in the system, such as those related to organizational culture. Culture influences what people see, hear, feel, and say. Perhaps most importantly, it influences the decisions and actions (behaviors) of people in an organization and these behaviors drive outcomes and performance.

Although the terms organizational culture and safety culture are sometimes used interchangeably, safety culture is typically defined as a focused area of an organization’s culture characterized by those factors that influence outcomes and performance specific to risk and safety. Understandably, a focus on safety culture is common in high-risk organizations.

Regulators have an important role to play in safety culture advancement as they can draw attention to the topic, raise awareness and understanding of cultural threats, look for signals of weakness and best practices and communicate them to industry to support learning. While most regulatory efforts related to safety culture have focused on improving the culture of regulated entities, there is evidence to suggest that regulatory agencies should equally invest in understanding their own cultural vulnerabilities and implications on regulatory oversight and the broader safety system.

Regulator safety oversight culture is a relatively new construct that was first identified by the International Atomic Energy Agency (IAEA) following the Fukushima Daiichi nuclear disaster. The IAEA’s report into that event noted the need for the regulator to possess a strong safety culture (i.e., safety oversight culture) and to assess it periodically.

A review of several major accident investigations illustrates the role of regulatory safety oversight culture in creating conditions that may detract from safety and environmental protection in high hazard environments (see table 1). The consequences of these events were catastrophic; lives were lost or changed forever and/or the environment sustained severe harm in each instance. Regulators that are committed to learning from these disasters and proactively influencing industry outcomes must consider technological, systemic, and cultural advancement in their efforts. This includes dedicating attention to their own oversight cultures.

A recent study revealed that the regulator safety oversight culture construct is comprised of six cultural vulnerabilities that require control and six contrasting cultural strengths that require nurturing. The negative dimensions include (a) a politicized mission, (b) a punitive culture, (c) the presence of bureaucratic inertia, (d) the tolerance of inadequate capacity and competency, (e) a compliance mentality, and (f) a preoccupation with active failures. The positive dimensions include (a) the presence of leadership and political independence, (b) a learning culture, (c) innovation, (d) technical excellence, (e) risk consciousness, and (f) systems thinking. 1

With improved cultural and system insight, regulators will be poised to contribute to safety and environmental

1 Bradley, C. (2017). Regulator safety (oversight) culture: How a regulator’s culture influences safety outcomes in high hazard industries (Doctoral dissertation). Available upon request.

Facilitators: Kate Bowers ([email protected]) and Claudine Bradley ([email protected]) Safety Culture Summit 2017 - Understanding Regulator Safety Culture

protection outcomes in more powerful and innovative ways. Name, Location, Date Inquiry Conclusions – Regulatory Contributing Factors to the Accident Consequences  Insufficient number of inspectors qualified to provide process safety oversight  Inadequate process safety training BP City Texas, U.S. (2005) 15 Fatalities and 180 Injuries  Inadequate number of inspections  Too great emphasis on workplace injury rates as driver for overall inspection priorities Facility and environmental damage  Ineffective oversight related to risk of catastrophic accidents ~20,000 barrels of crude oil  Inadequate regulation for assessing and repairing crack indications Enbridge Spill, Kalamazoo River, Residents self-evacuated from their  Ineffective oversight of pipeline integrity management programs, control center procedures, Marshall Michigan (2010) houses and public awareness. Environmental damage

 Inadequate regulations related to management of all safety critical elements throughout their lifecycle ~4 million barrels of released  Ineffective regulatory regime to address the risks of the Macondo well hydrocarbons BP Macondo Well Deepwater Horizon, Gulf of Mexico (2010)  Lack of awareness of the risks or narrow margins of safety associated with the well 11 Fatalities and 17 Injured  Inadequate training for key personnel and decision makers in regulatory domain Severe environmental damage  Ineffective use of real-time data analysis, information on precursor incidents or near misses, or lessons learned in the Gulf of Mexico and worldwide to adjust practices and standards appropriately ~47.6 million standard cubic feet of natural gas  Ineffective oversight of regulatory requirements for pressure testing, which likely would Pacific Gas and Electric have detected the installation defects 8 Fatalities and numerous injuries San Bruno, California (2010)  Ineffective oversight of company’s pipeline integrity management program Resulting fire destroyed 38 homes and damaged 70  Regulators’ crisis management system failed to function effectively in immediate aftermath

 Regulatory system supported faulty rationales for decisions and actions of operator

 Regulatory negligence and failure to implement adequate measures against a nuclear disaster High radioactive releases (a total of  Regulatory agencies characterized as having an insular attitude of ignoring international some 940 PBq (I-131 eq) Fukushima Daiihi Nuclear safety standards More than 1000 fatalities Disaster Fukushima, Japan (2011)  Ineffective monitoring or supervision of nuclear safety 4 nuclear reactors destroyed  Inadequate expertise of regulatory personnel

 Politicized mission described as collusion between operators, regulatory agencies, and agencies responsible for promoting nuclear energy

 Lack of regulatory transparency

 Failure to review and amend regulations in a timely fashion or to address predictable risks

Table 1

Facilitators: Kate Bowers ([email protected]) and Claudine Bradley ([email protected])