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24th Annual HPRCT Conference
June 19-22, 2018
Marriott Riverwalk
San Antonio, Texas
Tuesday, June 19
 

7:00am CDT

Continental Breakfast
Tuesday June 19, 2018 7:00am - 8:00am CDT
Alamo Ballroom

8:00am CDT

Welcome & Logistics- Day1
Charles Major, President of HPRCT delivers opening conference remarks

Speakers
avatar for Charles Major

Charles Major

Sr. Director of Operational Excellence and Human Performance at Vistra; President at the Community of Human & Organizational Learning, Luminant
Charles is an alchemist/evangelist/connector by nature and is passionate about big and disruptive ideas to improve the system/human interface and the leadership required to inspire discretionary effort. He leads the Operational Excellence & Human Performance efforts for Vistra; the... Read More →


Tuesday June 19, 2018 8:00am - 8:10am CDT
Alamo Ballroom

8:10am CDT

Systems and Choice:They're All We Have
Leaders strive to achieve highly reliable outcomes, yet as society we struggle to produce the results we want, from hospitals killing 440,000 patients each year in the US, to parents backing over 2500 kids each year.  Out of desperation, we fall back to blaming and sanctioning individuals for outcomes they did not intend to produce.  Yet, we simultaneously turn a blind to classes of more culpable workplace conduct, from racism and gender-bias to the outrageous behaviors being challenged by the “me too” movement. 
 
This presentation will provide a model for how leaders can create better outcomes through robust system design and individual accountability.  It will talk about the role of culture, and how culture can be shaped by leadership action.   
 
This presentation will provide a provocative look at the broader context of human performance that every CEO and organizational leader must address. 
 

Speakers
avatar for David Marx, BSE, JD

David Marx, BSE, JD

Founder, CEO, Outcome Engenuity
Outcome Engenuity, LLC was founded in 1997 by David Marx.David is the Chief Executive Officer of Outcome Engenuity. He has spent his career helping high consequence organizations develop values-supportive practices and culture. In the healthcare sector, David has been working to help... Read More →


Tuesday June 19, 2018 8:10am - 9:00am CDT
Alamo Ballroom

9:00am CDT

BREAK
Tuesday June 19, 2018 9:00am - 9:10am CDT
N/A

9:10am CDT

Profound Learning
Profound:  penetrating or entering deeply into subjects of thought or knowledge; having deep insight or understanding; originating in, or penetrating to the depths of one’s being; being or going far beneath what is superficial, external, or obvious.  These are some of the definitions of “profound.” 
 
Superficial learning allows us to restore the status quo fast so that we can return to our own agendas.  Profound learning, however, goes much deeper, questioning our “agendas themselves,” and so much more.  Profound learning takes time, will be painful and must end in introspection.   
 
This talk will focus on 3 words, and their impact on profound learning:   
 
The meaning of Manifestation 
The guarantee of Disillusionment 
The necessity of Introspection 
 
It will show how important it is to embrace the “manifestation” of the problem, and then use it to “disillusion” the right people, and then finally helping those same people to be “introspective.”  The talk is will include some practical takeaways that anyone will be able to use when things go wrong in their lives.  

Speakers
avatar for C.ROBERT

C.ROBERT

Founder/CEO, Failsafe-Network
C. Robert Nelms is a degreed Aerospace Engineer, having graduated from Texas A&M University in 1970. He worked at McDonnell Douglas until 1973, then became employed at Allied Chemical’s Nylon plant in Chesterfield, Virginia --an internationally recognized leader in Manufacturing... Read More →


Tuesday June 19, 2018 9:10am - 10:00am CDT
Alamo Ballroom

10:00am CDT

BREAK
Tuesday June 19, 2018 10:00am - 10:10am CDT
N/A

10:10am CDT

Renewable Energy Case Study: Application of resilience principles in the wind energy business
Renewable energy installations, especially wind farms, offer some dynamic challenges to building a robust learning culture due to the nature of the business.  Sharply downward price pressure for services, distributed work force, and remote locations are just some of these issues.  This session will cover some of these challenges and highlight a resilience based method that was used to increase success.  A method for applying a similar approach to any business will be offered.

Speakers
avatar for JP Conkwright

JP Conkwright

Director of Operations, Mortenson Energy Services
A broadly experienced business professional focused on improving business results through the implementation of Resilience and Safety 2 principles not only to safety topics but across a whole business.  JP’s experience spans 16 years through Safety, Quality, Marketing, and Operations... Read More →


Tuesday June 19, 2018 10:10am - 11:00am CDT
Alamo Ballroom

11:00am CDT

BREAK
Tuesday June 19, 2018 11:00am - 11:10am CDT
N/A

11:10am CDT

Connecting Human Performance and Root Cause Analysis
Because people have different models of how to explain a problem there are many different approaches to what’s called root cause analysis.  How an organization digs into a problem affects their set of available solutions from which to pick.  If a problem explanation is inaccurate or incomplete, the solutions can be off, perhaps just slightly.  The organization may be unaware that better solutions are even available.  You can’t miss what you’ve never had.

It’s common for investigations to terminate with human error or procedure not followed.  Everything in the job was going fine until a person did (or did not do) something.  The bottom line is, the person made an error.  That error and that person becomes the focus.  How do we do fix him or her?  This is the mental model of many organizations.  It’s true, the person made a mistake.  It’s just not the whole truth.  The error only a symptom.  Details need to be dissected.

The terms procedure not followed, human error and training less than adequate are related to people performing tasks.  All three falls under the human performance umbrella.  They’re also signals, not conclusions.  Companies spend time learning performance tools, studying human factors, reading books on human error and listening to experts.  Yet people are still leaving valves open, closing the wrong switch, and selecting the wrong item.  Companies know they’re supposed to work on the process, not the people.  But even when the process is improved people are still making errors.

There are completely different levels of human performance across industries and jobs.  Yet, organizations still search for that elusive human performance fix to make error rates lower.  People’s mental models for explaining a problem may be restricting their ability to see the other solutions.  Fundamentals lessons and basic concepts can sometimes get nudged aside in an organization by things that are newer and shinier.  This paper will review some common misconceptions about both root cause analysis and human performance and provide some simple examples of what high reliability systems look like.



Speakers
avatar for Mark Galley

Mark Galley

President, Instructor, Investigator, Certified Reliability Engineer, ThinkReliability
Mark has a Bachelor of Science in Mechanical Engineering from the University of Colorado in Boulder and obtained his certification as a Reliability Engineer in 1993 through the American Society for Quality.Mark’s practical experience in root cause analysis and work process reliability... Read More →


Tuesday June 19, 2018 11:10am - 12:00pm CDT
Alamo Ballroom

12:00pm CDT

Lunch
Tuesday June 19, 2018 12:00pm - 12:50pm CDT
River Terrace

12:50pm CDT

The Outward Mindset: Enabling Breakthrough Human Performance
Organizations, and teams are made up of individuals who work together every day to accomplish common goals. However, building a workforce that can successfully respond to perpetual challenges and consistently innovate relies on more than the outmoded behavioral solutions of the past. Rather by diagnosing and changing the underlying mindset that drives behavior, a workforce can become more flexible, collaborative, engaged, and high-performing. This is accomplished through a fundamental shift from the self-focus of an inward mindset to an outward mindset, which instead focuses on results and impact on others. This session will offer the necessary tools to achieve this shift in mindset. With these tools, participants will learn how to enhance impact and increase performance.

Speakers
avatar for Dave Moss

Dave Moss

Senior Consultant, The Arbinger Institute
Clients praise Dave for being informative, gracious, credible, and funny. He brings conviction, empathy, and energy to his speeches and is deeply interested in where people are and the organizational challenges they’re facing. People leave his presentations feeling understood, energized... Read More →


Tuesday June 19, 2018 12:50pm - 1:40pm CDT
Alamo Ballroom

1:40pm CDT

BREAK
Tuesday June 19, 2018 1:40pm - 1:50pm CDT
N/A

1:50pm CDT

Principles for Managing the Uncertainty of Human Error in Operations
Principles are ways of successfully and consistently dealing with reality when procedures and rules don’t make sense given the situation. This applies to not only front-line personnel but also to line managers. Managers cannot manage what they do not understand, especially at a systems level. The purpose of this presentation is to summarize seven time-tested, research-supported principles associated with operational risks associated with the uncertainty of human error. 

Speakers
avatar for Tony Muschara

Tony Muschara

Principal Consultant and Owner, Muschara Error Management Consulting, LLC
Tony began independent consulting in the field of human and organizational performance in 2007, helping managers of industrial organizations manage the operational risks associated with human performance. Tony authored following two books (published by Routledge and CRC Press, respectively):Risk-Based... Read More →



Tuesday June 19, 2018 1:50pm - 2:40pm CDT
Alamo Ballroom

2:40pm CDT

BREAK- Alamo Ballroom reconfiguration
30-minute break while air walls and technology is configured for breakout sessions

Tuesday June 19, 2018 2:40pm - 3:10pm CDT
N/A

3:10pm CDT

A Journey to High Reliability Operations – Theory to Practice
We have come to an understanding in various high-risk industries that a focus on High-Reliability Operations (HRO) is needed to; protect the public, our personnel as well as our assets and investment.
When it comes to protecting the public, what should companies consider? Who is the public? This presentation is for any industry with similar interest.
The journey to HRO is like improved and sustainable industrial safety; it’s never-ending!
What does it mean to operate with high reliability? What is it based on? What are the roles of both management and the worker at the sharp-end? How can we have high reliability with human fallibility? Where does accountability fit? How do I help my organization start this journey? What will it take to sustain the effort?
All these questions will be answered during this presentation as HOPE Consulting LLC combines successes, experiences and knowledge with Muschara Error Management, LLC.



Speakers
avatar for Ed Gatto

Ed Gatto

Consultant, HOPE Consulting, LLC.
As consultant with Hope Consulting, Ed works with clients across the U.S. to improve human performance, supervisor/worker relationships, and site culture. Ed’s experience includes 38 years in the electric power industry with 20 years specifically focused on Human Performance including... Read More →
avatar for Rey Gonzalez

Rey Gonzalez

President, HOPE Consulting, LLC
Rey Gonzalez Owner/President of HOPE Consulting LLC has spent most of his professional life working to improve overall safety, efficiency, and profitability through the enhancement of human and organizational performance.Over the past 28 years, Rey has done so by helping management... Read More →
avatar for Tony Muschara

Tony Muschara

Principal Consultant and Owner, Muschara Error Management Consulting, LLC
Tony began independent consulting in the field of human and organizational performance in 2007, helping managers of industrial organizations manage the operational risks associated with human performance. Tony authored following two books (published by Routledge and CRC Press, respectively):Risk-Based... Read More →


Tuesday June 19, 2018 3:10pm - 4:00pm CDT
Salon B

3:10pm CDT

Could this Happen Again? A Resilience Engineering View of a NASA Event
Roughly 4 years ago, Luca, an astronaut from Italy, nearly drowned during a spacewalk after a potentially dangerous amount of water accumulated in his helmet.   After this event, NASA performed a traditional root cause analysis and implemented corrective actions.   Then NASA asked, “Could this happen again?”  Looking to resilience engineering to provide a different perspective, International Space Station leadership commissioned a team to assess and make recommendations to increase the resilience of their organization.  In this talk, I report on elements the team deemed relevant in assessing resilience and brittleness.  I contrast resilience engineering with traditional root cause analysis, both in how an event is analyzed and the differences in subsequent strategies and actions including methods to increase resilience.    

Speakers
avatar for Beth Lay

Beth Lay

Founder and Principal, Applied Resilience, LLC.
An experienced leader who helps develop resilient, reliable organizations. Four years experience as Director of Human Performance at Calpine Corp – an owner/operator of 80+ electric utility power plants. Seven years experience as the leader of Siemens Energy Field Service Risk Management... Read More →


Tuesday June 19, 2018 3:10pm - 4:00pm CDT
Travis

3:10pm CDT

Pros & Cons of Three Core Strategies for Managing Workplace Errors
Some HPI experts tell us to reduce human errors. Others warn us to stop focusing on the “humans.” Still others, argue that “errors” don’t exist at all. If you’re confused, you’re not alone. Join us to cut through the confusion and learn pros and cons of each of these three core error management strategies:
  • Apply Classic Defenses
  • Improve Work Processes
  • Build Organizational Resilience
Practical, real-world examples included as always.

All participants will receive a copy of the “Three Strategies” handout.


Speakers
avatar for Jake Mazulewicz, Ph.D.

Jake Mazulewicz, Ph.D.

Director, JMA Human Reliability Strategies, LLC
Many companies try to eliminate errors, but can’t. Dr. Jake shows leaders in high-hazard industries why errors are signals, not failures, and how to address the deeper problem, so that everyone can work more reliably and safely. He specializes in making Human Performance & HOP practical... Read More →


Tuesday June 19, 2018 3:10pm - 4:00pm CDT
Salon A

3:10pm CDT

Corrective Action Plan Development: A Structured Approach
Rick Foote, co-author of IEEE Standard 1707-2015 (IEEE Recommended Practice for the Investigation of Events at Nuclear Facilities), will lead a session intended to help attendees identify stronger, leaner, and more cost-effective corrective action plans in response to significant incidents.
While many investigation approaches include detailed processes and structured tools for identifying the causes of incidents, few provide more than minimal guidance when it comes to developing the associated corrective action plan.  As a result, organizations often struggle when it comes to implementing sustainable corrective actions that reduce the risk of incident recurrence to acceptable levels.    
 Attendees will learn a structured approach for resolving incidents with ‘surgical strikes’, thereby avoiding costly ‘shotgun’ corrective action plans that seek to address everything (while often resolving nothing).  Attendees will also learn how to distinguish between corrective actions that are truly capable of long-term risk reduction and those that provide no lasting benefit.  Rick will also discuss good practices for assessing the overall effectiveness of corrective action plans, as well as ensuring corrective actions are not inadvertently modified or deleted after implementation

Speakers
avatar for Richard Foote

Richard Foote

Senior Consultant, Fisher Improvement Technologies
Rick Foote is a Senior Consultant with Fisher Improvement Technologies Inc. and co-author of IEEE Standard 1707-2015 (Recommended Practice for the Investigation of Events at Nuclear Facilities).  He has 30+ years of experience as a team leader and mentor for incident analysis teams... Read More →


Tuesday June 19, 2018 3:10pm - 4:00pm CDT
Salon C

3:10pm CDT

Top-Ten Common Cause Patterns
This session will examine the top-ten causal patterns.  It will demonstrate different specific manifestations of these patterns.  And it will demonstrate how to string combinations of causal patterns together to analyze a problem.
People are very good at identifying patterns in the random chaos of nature.  We use these patterns to help us quickly recognize and respond to opportunities and threats.  These patterns are built through experiences – we are not born with them.  And since we all have unique experiences, we each build a unique set of causal patterns that help us navigate our specific corners of the world.
This pattern-recognition process occurs in root cause analysis as well.  After investigating dozens of events, consistent similar causal patterns start to materialize.  The more-experienced investigators use these patterns to help analyze the causes of new events.  The use of patterns, or templates, helps dramatically decrease the time to complete an RCA and helps to ensure a more accurate and thorough analysis.
As instructors, we often hear the comment “It looks easy... when you do it!”  And so it is.  A major factor in why this is true has to do with how the experienced investigator collects, accesses, and deploys their unique set of causal patterns.

Speakers
avatar for Brian Hughes

Brian Hughes

President, Co-founder, Sologic
President & Co-founder of Sologic, a global provider of root cause analysis training, consulting, and software.  Since 2000, Brian has worked with clients to develop and implement enterprise-wide RCA programs.  He leads significant incident investigations, including explosions... Read More →


Tuesday June 19, 2018 3:10pm - 4:00pm CDT
Salon E

3:10pm CDT

“SWARMing” to improve Patient Safety
SWARMs allow the organization a standard process for reviewing the system when it does not perform as expected. This allows for critical information to be retained and thus immediate actions to occur while working on continuous process improvement in standard work fashion and while building and supporting a culture of safety.


Summary:
WHAT: SWARMing for Patient Safety allows the organization to review and obtain the details of an “incident”.  This being an occurrence that is not consistent with the routine operation of the hospital and outpatient areas or with the standard quality of care rendered to a particular patient.
WHY: SWARMing in real time allows the ability to get the facts and details without losing critical information.  It helps maintain a culture of safety and transparency.  This allows the organization to have a systems based approach that is standard among all associates. This allows for us to have an ability to get the appropriate immediate fix after learning the problem and identify the “5 whys” in order to plan longer term action plans.
WHO: The frontline staff is fully invested as this is a safe and respectful venue without blame.  This is appreciated from the teams and it is recognized as a venue for each team member to be heard and express their concerns.
HOW: It is a 5 step process: 1) Introduction and Review of the process, 2) Timeline of events to review the facts and identify the care delivery problems, 3) Address countermeasures and action items, 4) Assign a responsibility “R” owner for each item, including date of completion 5) Assign overall “R”.  The swarm form is completed and sent to all staff involved including risk, leadership, accreditation and safety.  Follow up is done within a week to address gaps in the action items and potential need for follow up.  The goal is to identify the correct diagnosis of the problem in order to complete action items that will actually impact the system.  All significant, sentinel or events deemed by safety to be high risk to the organization have a 60 day follow up and closure with tracking of actions.
Overall all healthcare organizations need to perform Root Causes analysis in compliance with The Joint Commission.  The method of SWARMing has been accepted by them in replacement of traditional RCAs.
Since instituting SWARMS at our organization our rates of incident reports have increased and stabilized and our sentinel and significant events have decreased annually for three years.

Speakers
avatar for Renee Hebbeler-Clark, M.D.

Renee Hebbeler-Clark, M.D.

Associate Professor of Clinical Medicine, UC College of Medicine, University of Cincinnati Health System
Critical Care Medicine and Infectious Diseases PhysicianUC Health Medical Director Patient Safety-Chief Patient Safety OfficerChair CPR Committee, UC HealthUniversity of Cincinnati College of Medicine


Tuesday June 19, 2018 3:10pm - 4:00pm CDT
Salon D

3:10pm CDT

HUDDLE UP TO MOVE UP
Share DTE Energy’s use of “huddles” to make current results visible, engage frontline teams in scientific method based problem solving, integrate 2 tier coaching, and share improvements across the organization.

  •  Introduce DTE’s approach to “Huddles”
    • What do you Huddle about?
    • Length, location and frequency of a huddle
    • Involve the front line
    • Huddle agenda
    • Do the pre-work
    • Get the data
    • Build off a Standardized format (Quality, Cost, Delivery)
    • Trend the data
    • Develop countermeasures based on trending of data
  • Review examples of huddles
  • Additional elements to a huddle
    • Go to the point of occurrence
    • Use the scientific method
    • Make the problems and progress visible
    • Leaders coach
    • Share what’s learned
  • Q & A
What does a good day’s work look like for your Team?  What are the things that prevent us from having a good day?  Does your team experience recurring defects? What does the data say? Is there significant performance or process gaps that affect your metrics?

Speakers
avatar for Tim Anderson

Tim Anderson

Manager, Quality Assurance, DTE Energy
Tim has been with DTE Energy for 18 years.  He began as a Power Plant Operator and then Maintenance Apprentice at two coal-fired plants.  He then joined the Controllers Organization to provide financial and decision support for four power plants and periodic outage teams. In that... Read More →


Tuesday June 19, 2018 3:10pm - 4:00pm CDT
Salon F

4:00pm CDT

BREAK
Tuesday June 19, 2018 4:00pm - 4:10pm CDT
N/A

4:10pm CDT

Efficiency Thoroughness Trade Off – Finding the right balance to achieve Operational Excellence
In business, excellence is the characteristic that causes customers to choose your product(s) and services over the competition.  Achieving the proper balance between discipline, reliability and flexibility defines that excellence.  The efficiency/thoroughness tradeoff.  Achieving this balance in industries with potentially high consequence failures such as Bhopal, Tenerife or Fukushima Daiichi is literally a vital skill.  This session will introduce a business model that integrates Operational Discipline, Highly Reliable Organizing and Resilience principles that can be used to evaluate your organization.  It will also provide brief case studies supporting the use and application of this model. 
 

Speakers
avatar for Tony Wiseman

Tony Wiseman

Training Manager, Calpine Corporation
Tony Wiseman is a recognized expert on power plant training and staffing, including work in the US Navy Nuclear Power Program, Progress Energy Carolinas, and Calpine Corp., and is currently Calpine’s Training Manager.  At Calpine, he leads the Operations Excellence program, incorporating... Read More →


Tuesday June 19, 2018 4:10pm - 5:00pm CDT
Travis

4:10pm CDT

Risk-Based Thinking: Managing the Uncertainty of Human Error in Operations
This breakout is a follow-on discussion of the plenary session on Principles. It is intended to spur discussion on the integration and execution of Risk-Based Thinking (using my book as a resource) at a high level. This applies to not only to line managers but also H&OP practitioners. The take away from this session includes a set of activities that participants can start doing right away when they return to their place of work. 

My intent is to summarize the role managers play in controlling human error risks, learning to enhance system reliability and resilience, and building adaptive capacity in their high-hazard operations. 
 
I will propose the six building blocks of managing H&OP listed below, promoting a discussion of what can be done in each: 
 
  1. Adapt: integrating risk-based thinking and chronic uneasiness into the culture 
  1. Control: maintaining positive control of critical steps and risk-important actions 
  1. Systems Learning: systematically and relentlessly detecting and correcting latent conditions that inhibit the effectiveness of defenses and create landmines and error traps in the workplace. 
  1. Training and Expertise: review of the need for technical knowledge and skill, and a systematic approach to training 
  1. Observation and Feedback: review of managers’ role in promoting systems learning by firsthand monitoring of real-time work practices and conditions 
  1. Integration and Execution: promoting the value of risk-based thinking/chronic uneasiness and explicitly managing the operational human performance risk. 
 
The session concludes with a summary of key takeaways for each building block. 

Speakers
avatar for Tony Muschara

Tony Muschara

Principal Consultant and Owner, Muschara Error Management Consulting, LLC
Tony began independent consulting in the field of human and organizational performance in 2007, helping managers of industrial organizations manage the operational risks associated with human performance. Tony authored following two books (published by Routledge and CRC Press, respectively):Risk-Based... Read More →


Tuesday June 19, 2018 4:10pm - 5:00pm CDT
Salon B

4:10pm CDT

Brain-Based Safety Culture
As a forward-thinking and responsible leader, your interest may be piqued by the promises of modern safety culture: theory that describes the daily sociotechnical complexities of your work, the potential to move beyond toxic blame culture, the hope offered by a more appreciative approach to process improvement. But when you are back at your job site or workstation, you may still witness a good worker being fired because “someone’s head had to roll,” or a disagreement escalating into a shouting match and rank being pulled to settle the outcome. Perhaps you even see yourself in those very real, very common situations. 
 
So what is it that makes traditional safety culture so easy and satisfying in the short term? What gives modern safety culture and an HRO-mindset a scientific likelihood to succeed in the long term and deliver more return on your investment? What actions can you count on to facilitate or destabilize worker motivation? The answers lie in our most basic, 300-million-year-old human biology. Modern research into brain activity utilizing functional MRI and classic behavioral interventions shed new light on otherwise elusive concepts. 
 
After this 25-minute interactive seminar, you will learn how to: 
1. Map positive and negative social stimuli to the activation of common neurotransmitters in specific regions of the brain.  
2. Predict how your leadership approach – even down to individual choices – may influence the workers and teams in your shop on a neurological level. 
3. Infuse your leadership decisions with evidence-based social and behavioral neuroscience. 
*No biology or medical knowledge required; all are encouraged to attend. 

Speakers
avatar for Christine Jefferies. MSN, RN

Christine Jefferies. MSN, RN

Clinical Coordinator for Ear, Nose, and Throat Surgery, Children’s National Medical Center (CNMC)
Christine Jefferies is a Registered Nurse working as a Clinical Coordinator for Ear, Nose, and Throat Surgery at Children’s National Medical Center (CNMC), in Washington, DC. After earning her Master’s Degree in Nursing from the University of Virginia (UVA) in 2010, Christine... Read More →


Tuesday June 19, 2018 4:10pm - 5:00pm CDT
Salon E

4:10pm CDT

Series of Yellow Lights: Situational Thinking
The expected response to workplace ‘green and red lights’ rarely result in error or undesirable consequences, whereas the uncertainty produced by ‘yellow light’ moments eventually do. Though highly predictable and easily recognizable, managers, first line supervisors, work planners and front-line workers continue to speed through the workplace intersection when encountering a yellow light moment, regretting the decision in both the short and long run.  During this interactive session, participants will recognize their own yellow light issues, the cognitive biases that create unproductive and unsafe responses and actions and the five error reducing techniques High Reliability Organizations use to turn perilous yellow lights into reliable green and red-light decisions.  

Speakers
avatar for Joe Estey, Sr.

Joe Estey, Sr.

Senior Performance Improvement Specialist, CHOLearning Director, Lucas Engineering & Management Services
Joe Estey has over 40 years’ experience training and consulting first line workers, foremen, supervisors, department managers and executives in Human Performance Improvement and effective leadership and management principles and practices. He works routinely with forest management... Read More →


Tuesday June 19, 2018 4:10pm - 5:00pm CDT
Salon A

4:10pm CDT

Blind Spots From the What Lies Beneath Series
Getting to true root causes has proven to be elusive in many HSE incidents. Why is it so and how can we tell whether we are getting to true root causes. 
 
Blind Spots is a facilitated session where we will introduce the idea of blind spots and discuss how we can identify and eliminate these to improve our ability to find true root causes in HSE incidents. Blind spots is part of our What Lies Beneath series that prompts an organization to dig deeper and look for systemic issues. We will share our lessons learned from a case study and discuss the use of clear vs. tinted lenses. The session includes a combination of presentation, video, handouts, and discussions that concludes with a call to action, providing attendees with an opportunity to consider how we can apply our learning to make a difference. 

Speakers
avatar for Mary Fernandes

Mary Fernandes

Global HSE Training Manger, Baker Hughes
Mary Fernandes is the Global HSE Training Manager for Baker Hughes, a GE Company. She is based in Houston and has over 16 years of international experience in the oil and gas industry.She is currently pursuing her MSc. In Psychology of Work degree.


Tuesday June 19, 2018 4:10pm - 5:00pm CDT
Salon C

4:10pm CDT

Clean listening and knowing When Your Opinion Matters
Aims & Outcomes 
 
The aim of this interactive presentation is for you to learn the principles of Clean Language and learn a brief model that lets you begin using Clean Questions and the principles behind this methodology right away. 
 
Problem  
 
Knowing when your opinion matters is a high-level calibration when gathering information from others. Listening is not a passive activity. It is the most active thing you can do. To ask really good questions - questions that are powerful, useful, and appropriate - one needs to listen actively and accurately. It is easy to be lulled into believing that enacting these behaviors is unproblematic and requires little specialist skill.  
 
Clean Listening, as distinct from ‘active listening’ and ‘paraphrasing’, is like a martial art requiring knowledge, practice, and tactical actions.  
 
Empirical research shows that even a single word (especially a metaphor) or presupposition can materially ‘lead the witness’.  
 
 
Solution  
 
Clean listening, the application of Clean Language, reduces unintended bias and protects the integrity of the information you are seeking. Clean questions keep focused on the topic in question without restricting or leading them. It helps you keep your opinions, suggestions, assumptions, and personal metaphors to yourself when it matters most.  
 
 
Objectives 
 
The presentation will provide background information and practical activities for participants to learn: (1)  where clean language comes from, (2)  how bias is unintentionally introduced into a conversation, and (3) how to use the most useful classically clean questions. 
  
Skills & Activities  
 
Participants will:  
 
•Learn the most useful Clean Language Questions and begin using them right away. 
 
•Experience the felt difference between answering clean questions and those containing 
leading presuppositions and metaphors. 
 
 
•Learn and practice the One Minute strategy - a simple Clean Question Model that is helpful in task development and follow-through 
 
 
•Experience listening as an active component of curiosity and solution focused activities.  
 
•Experience Clean Questions in action as Facilitating Cleanly is modeled by the presenter and see how one can use this methodology live with an interactive group.  
 
 

Speakers
avatar for Sharon Small

Sharon Small

Clean Language Facilitator and Trainer, The Clean Language Institute
Sharon Small is an independent researcher and internationally recognized Clean Language trainer and assessor. She has over 13 years of experience working in the nuclear industry, a degree in psychology, and background in NLP. She is the author of The End of Therapy, co-editor of... Read More →


Tuesday June 19, 2018 4:10pm - 5:00pm CDT
Salon D

4:10pm CDT

DevonWay Universal Trending
Case study presentation and a brief demonstration of DevonWay Universal Trending

DevonWay has recently introduced integrated statistical trending within their
no-code software platform. The primary goals of this effort are to:

1) Extend conventional, statistical trending to business users who are versed
in statistical concepts but do not have access, budget, proficiency, or motivation to use Minitab, SAS, or other complex statistical tools

2) Easily and quickly deploy statistical calculations and controls to underlying data and

3) Apply these statistical calculations and controls to any and all data that resides in the database, not just Corrective Action & Issues Management data. DevonWay offers many modules to support continuous improvement, safety, quality management, and work management functions and our belief is that easy and accessible statistical trending adds value in all of these areas.

The focus of this session will be on actual statistical results and findings across
utility customer datasets, both individual results and in aggregate by mapping
trend codes between customer utilities. We will explore findings within the CAP
program and apply statistical controls to compare against safety observation data
across the same time period. We will share customer insights, operational events,
corrective actions, and case studies to add additional color to the statistical
insights presented in this session.



Speakers
avatar for Millie Ruchti

Millie Ruchti

Director of Enterprise Accounts, Devonway
Millie Ruchti is DevonWay’s Director of Enterprise Accounts. She manages DevonWay's relationships with some of our largest customers, advocating for their success through the use of DevonWay's products and services. With responsibility for the overall health and delight of DevonWay's... Read More →


Tuesday June 19, 2018 4:10pm - 5:00pm CDT
Salon F

5:00pm CDT

HPRCT Board Meeting
Tuesday June 19, 2018 5:00pm - 6:00pm CDT
TBA
 
Wednesday, June 20
 

7:00am CDT

Continental Breakfast
Wednesday June 20, 2018 7:00am - 8:00am CDT
Alamo Ballroom

8:00am CDT

Welcome & Logistics- Day 2
Charles Major, President of HPRCT delivers Day 2  remarks

Speakers
avatar for Charles Major

Charles Major

Sr. Director of Operational Excellence and Human Performance at Vistra; President at the Community of Human & Organizational Learning, Luminant
Charles is an alchemist/evangelist/connector by nature and is passionate about big and disruptive ideas to improve the system/human interface and the leadership required to inspire discretionary effort. He leads the Operational Excellence & Human Performance efforts for Vistra; the... Read More →


Wednesday June 20, 2018 8:00am - 8:10am CDT
Alamo Ballroom

8:10am CDT

Engaging Leadership and the Global Progress of Integrating Personality Tendencies Into HP
Rob will describe and discuss ways to get leaders to engage including "values-based" engagements and use of the Essential Leadership Cycle. He will also describe some of the progress made with integrating personality tendencies into traditional HP and some of the outcomes on a global scale.

Speakers
avatar for Rob Fisher

Rob Fisher

President, Fisher Improvement Technologies
Rob is a pioneer in Human and Organizational Performance and all aspects of organizational learning including incorporating the understanding of personality diversity into risk management.  He brings an integration mentality to consulting, along with a globally recognized capability... Read More →


Wednesday June 20, 2018 8:10am - 9:00am CDT
Alamo Ballroom

9:00am CDT

BREAK
Wednesday June 20, 2018 9:00am - 9:10am CDT
N/A

9:10am CDT

Uh-Oh: Learning from Adverse Events Using RE and HRO Methods
Organizations are responsible to protect their employees and the public from injury and death. Safety researchers (such as the authors of this session) seek to improve understanding of operational performance in order to strengthen systems safety.
     Safety pivots on understanding actual operations. Different fields of practice have developed different approaches to accomplish this. Various safety research methods including those from Resilience Engineering (RE) and High Reliability Organization (HRO) lead to insights that can be used to improve system performance and safety margins.
    This session will invite participants to consider approaches to learning from events with adverse outcomes. In order to provide enough time for interaction and discussion, we expect to cover two events:  a U.S Navy ship collision at sea, and a near-fatal extra-vehicular activity (EVA) at the International Space Station. We will briefly describe the two events, ask attendees what method(s) they would use to learn about them, then provide a RE and a HRO perspective. The audience will be invited to compare their own views on the value of the two approaches.
     The session is expected to enrich participant understanding of how different approaches yield different insights into safety, and obstacles that prevent learning from adverse events in their own organizations.  

Speakers
avatar for Chris Nemeth, Ph.D.

Chris Nemeth, Ph.D.

Principal Scientist III, Applied Research Associates, Inc.
Christopher Nemeth, PhD, CHFP, is a Principal Scientist III with Applied Research Associates, an 1100-member national science and engineering consulting firm. His recent research interests include technical work in complex high stakes settings, research methods in individual and distributed... Read More →


Wednesday June 20, 2018 9:10am - 10:00am CDT
Alamo Ballroom

10:00am CDT

BREAK
Wednesday June 20, 2018 10:00am - 10:10am CDT
N/A

10:10am CDT

Turning 'Facebook Safety' Into a Culture of Safety
Summary Abstract: We have all observed the typical, picture-perfect ‘Facebook’ family online.  Such pictures give the appearance that everyone in this family gets along famously and they don’t have a worry in the world.  
  
Oftentimes the safety systems we have in place also give us the appearance of a worry-free safety culture.  This is because our corporate safety reporting leads us to believe, because of the low incidence of reported injuries, that we are a model for a ‘culture of safety’.  As a result, we may even be confident enough that we publish papers and speak at conferences on our safety success. Others then try and replicate our success. 
 
However, could our reality be that we have a false sense of security? Are we experiencing a kind of ‘Facebook’ Safety System?   
 
This presentation will explore our current safety assumptions and offer new safety assumptions that may be a more accurate measure of a true ‘culture of safety’.  We will also discuss how effective reliability, quality, and safety systems depend on each other for success, instead of operating in independent silos.  
 
Current Assumptions: 
  • Safety is a system problem created by the introduction of the (external) unreliable human (e.g. - people are the problem) 
  • Safety is unrelated to, or considered as a measure of, process quality or system reliability 
  • Safety is externally regulated, whose internal effectiveness is most often measured by the absence of safety (as indicated by fatalities, lost-time injuries, OSHA recordables and near-misses) 
  • The functioning system would experience no dysfunction if it were not for unreliable workers (e.g. - people are external to system performance and safety) 
  • Our National system for rule-making is reactive, as it is based on frequency and severity of failures that have already occurred 
  • Reactive compliance with safety regulation is the fulcrum point of decision-making (e.g. - safety seen as a constraint) 
  • Compliance-based safety is an effective measure of a 'safety culture' 
  • There is no correlation between system safety and system reliability  
  • Reliability is a component property, therefore it only focuses on why parts fail (e.g.  system function = sum of individual component function) 
  • Reliability investigations are linear in structure and conclude with a single 'root cause' 
 New Assumption 
  • Measuring the presence of safety is an effective measure of a 'culture of safety' (e.g. - people are integral to system performance and safety) 
  • A correlation between quality, reliability, and safety does exist 
  • System breakdowns, or component failures, increase the probability of an injury-provoking incidents 
  • Effective proactive and reactive analysis of such breakdowns require the understanding of socio-technical and organizational influences on decision-making at the floor level in complex systems 
  • Analyses should focus on ensuring the availability of information and resources necessary for effective, reliable decisions, facilitating overall system resilience, as opposed to only the decision outcomes (e.g. - hindsight bias) 
  • Engaging the workforce in proactively identifying current hazards, exposures, risks and process solutions to prevent system breakdowns in the first place (e.g. - people are the solution) 
 

Speakers
avatar for Ron Butcher, CSP, CHM, CMIOSH

Ron Butcher, CSP, CHM, CMIOSH

Independent Consultant, Independent Consultant
Ron Butcher’s passion for safety can be traced back to his childhood when, as a curious 3-year-old armed with his sister’s hairpin and unfettered access to the outlets of their home, he discovered the world might not be as safe as he’d been led to believe. As seasoned strategist... Read More →
avatar for Robert Latino

Robert Latino

Principal, Prelical Solutions, LLC.
Bob Latino is currently a Principal of Prelical Solutions, LLC. Bob was the former CEO of the Reliability Center, Inc. (RCI), until its acquisition in 2019. The Latino family founded, directed and owned RCI since 1972.He is an internationally recognized author, trainer, software developer... Read More →


Wednesday June 20, 2018 10:10am - 11:00am CDT
Alamo Ballroom

11:00am CDT

BREAK
Wednesday June 20, 2018 11:00am - 11:10am CDT
N/A

11:10am CDT

Introduction of a Human Performance Program into an organization.
Introduction of a Human Performance Program into an organization. 
 
  1. Incorporating a Risk and Resource Management (RRM) process through its uniform implementation, maintenance of fidelity, and standardization of across the Southwest Airlines enterprise. 
  1. Involving stakeholders through council as the subject matter expert (SME) of human factors and ergonomics to support the Safety Management System by providing a framework that enables collaboration with departments to integrate human-centric principles and current industry best practices into training, standards, policies, procedures, investigations, daily operations and safety management systems. 
  1. Interfacing with Government, Academic, and Industry leaders through the creation of research opportunities and general collaboration. The Principal Scientist of Human Performance is the primary point of contact with human factors and ergonomics entities outside of Southwest Airlines. 

Speakers
avatar for P. David Yacht

P. David Yacht

Principal Scientist of Human Performance, Southwest Airlines
Born in Miami, Florida, David Yacht attended Embry-Riddle Aeronautical University and earned Bachelor of Science in Professional Aeronautics, Master of Aeronautical Science, and Master of Science in Human Factors and Systems. Yacht is currently enrolled in The University of Texas... Read More →


Wednesday June 20, 2018 11:10am - 12:00pm CDT
Alamo Ballroom

12:00pm CDT

Lunch
Wednesday June 20, 2018 12:00pm - 12:50pm CDT
River Terrace

12:50pm CDT

Your Ultimate Offense
“Human Performance” continues to be viewed primarily as a mechanism for reducing errors, and perhaps for how to better ‘figure things out’ AFTER something has gone wrong.
While reducing errors and learning from mistakes are critically important, primary focus in these areas is a Defensive Posture.
As we continually witness in virtually all sports, the BEST way to reach championships (and win them) is through a strong OFFENSE.
In truth, [appropriate] focus within the realms of human behavior and “human performance” offers exceptional leverage at developing a strong Offense- in ANY arena of performance improvement.
The results of focusing on OFFENSE go far beyond mere reductions of error.  Achieving proper culture and climate achieve sustained next-level results in all four arenas critical to organizational performance: Reliability, Efficiency, Productivity, AND Safety.
Drawing off 13 years of PPI development and in-field experience working with tens of thousands of workers and their leaders in various industries around the globe, and 20 years US nuclear experience prior to that, this presentation draws a conclusion whose time has arrived: Human Behavior is the ultimate Offensive Strategy.
The stage is now perfectly set for a strategic shift in mindset- ‘old-school’ leaders are in the twilight years of their careers, while Xers and Millennials begin to take the reins of decision and momentum.
During this presentation, Tim Autrey will energetically enlighten and educate General Session participants in:
  • The tremendous leverage offered by an Offensive focus on Human Behavior
  • How human performance honestly follows a different set of rules
  • Your true GOAL in any performance improvement effort
  • How to avoid conflicts and alternate agendas while simultaneously improving Reliability, Efficiency, Productivity, and Safety.
  • How to better Influence behaviors across generations
There will be two special features of Tim’s presentation:
1. Tim will be releasing his next book just prior to the conference.  Simply titled “Human Performance”, it is a handbook to be used by anyone seeking the next-generation path- taking Strategic Offense through proper focus on the CORE of all performance improvement.  He will be making copies of this book available to a substantial portion of the HPRCT participants free of charge.
2. At the conclusion of his session, Tim will provide participants access to the PPI IQ (Influencer Quotient™) personal assessment.  This is an online assessment that HPRCT participants can take free of charge during the conference.  Participants will be encouraged to complete the assessment during the afternoon/evening of Day One.  Their personal results will be shared with them via email, as well as during Stacey Hefner’s Breakout presentation (see Stacey Hefner’s abstract- Influencing Across Generations).
This assessment is normally only available for participants in the Practicing Perfection® Human Performance MASTERS Program™.
At the conclusion of Tim’s presentation, participants will be challenged to be bold, to be passionate, to be exceptional.   

Speakers
avatar for Tim Autrey

Tim Autrey

Founder/CEO, Practicing Perfection Institute
Tim Autrey is a recognized thought leader in performance improvement. Through his ground-breaking approach known as Practicing Perfection® and creation of the Practicing Perfection Institute, Inc. (PPI), and PPI Global, Ltd., he and the PPI Team have helped organizations around the world develop Next-Generation Leadership while reducing human error and enhancing performance in all arenas through a holistic approach to “human performance”.Tim has been a student of behavioral psychology since his earliest days. He spent... Read More →


Wednesday June 20, 2018 12:50pm - 1:40pm CDT
Alamo Ballroom

1:40pm CDT

BREAK
Wednesday June 20, 2018 1:40pm - 1:50pm CDT
N/A

1:50pm CDT

Leadership By Design
As Hollnagel described in Safety II: Resilience in Practice, we have moved from the protective safety era to a productive era, a time when risk aversion must be replaced with risk competency. This transition is being made at a time when 48% of the current workforce will retire within the next 3-5 years, while 53% of our workforce will consist of Generation Alphas, Generations WHY’ers and Generation D’ers. In the midst of these changing realities, what should leaders know, practice and expect from the efforts, actions and decisions of those needing to be co-invested with them in achieving organizational; excellence? During this exploration of leadership principles and practices, Estey will share first-hand experiences from the lessons he has observed while working with manufacturing, construction and engineering/project management firms across the United States.



Speakers
avatar for Joe Estey, Sr.

Joe Estey, Sr.

Senior Performance Improvement Specialist, CHOLearning Director, Lucas Engineering & Management Services
Joe Estey has over 40 years’ experience training and consulting first line workers, foremen, supervisors, department managers and executives in Human Performance Improvement and effective leadership and management principles and practices. He works routinely with forest management... Read More →


Wednesday June 20, 2018 1:50pm - 2:40pm CDT
Alamo Ballroom

2:50pm CDT

HRO/Resilience in Practice – A Panel Discussion
There are numerous examples, both old and new where a company, a government, or an entrepreneur has found the sweet spot in complex operations between control and adaptation. Much needed discussion is occurring currently to better define the theory behind these successes. There is also a need to discuss them from the other side, that is from the perspective of the implementers, the operations side.  This panel will do that.
 
This session will consist of:
  • An introductory discussion of whether HRO/Resilient operations are a recent creation or a dawning realization of applicability? (10 minutes)
  • Short presentations of key success factors in the implementation of HRO/resilient practices in four industries: oil/gas, power, national security, and healthcare. (30 minutes)
  • A moderated panel discussion of the pressures and change management approach that made success possible. (20 minutes)
  • A moderated question and answer session for participants. (30 minutes)
 The idea is to focus on examining /HRO/Resilient operations from the standpoint of application – the moderators will have prepared questions to seed conversation and will have pre-defined minimum content for presentations and limits to facilitate moderating questions.

Moderators
avatar for Beth Lay

Beth Lay

Founder and Principal, Applied Resilience, LLC.
An experienced leader who helps develop resilient, reliable organizations. Four years experience as Director of Human Performance at Calpine Corp – an owner/operator of 80+ electric utility power plants. Seven years experience as the leader of Siemens Energy Field Service Risk Management... Read More →
avatar for Jim Marinus

Jim Marinus

Owner, Jamar Operations
Jim specializes in high-risk operations management, high reliability, and resilience, and is the principal consultant and owner of Jamar Operations, LLC (2015-present). When not consulting, Jim is actively involved with the international communities of practice for H&OP, high reliability... Read More →

Speakers
avatar for Renee Hebbeler-Clark, M.D.

Renee Hebbeler-Clark, M.D.

Associate Professor of Clinical Medicine, UC College of Medicine, University of Cincinnati Health System
Critical Care Medicine and Infectious Diseases PhysicianUC Health Medical Director Patient Safety-Chief Patient Safety OfficerChair CPR Committee, UC HealthUniversity of Cincinnati College of Medicine
avatar for Gus Sinnis, Ph.D.

Gus Sinnis, Ph.D.

Accelerator Director- Los Alamos Neutron Science Center, Los Alamos National Laboratory
Dr. Gus Sinnis is Director of the Los Alamos Neutron Science Center (LANSCE) and Deputy Associate Laboratory Director for Experimental Physical Sciences at the Los Alamos National Laboratory. LANSCE is a premier accelerator-based user facility for research underpinning Laboratory... Read More →
avatar for P. David Yacht

P. David Yacht

Principal Scientist of Human Performance, Southwest Airlines
Born in Miami, Florida, David Yacht attended Embry-Riddle Aeronautical University and earned Bachelor of Science in Professional Aeronautics, Master of Aeronautical Science, and Master of Science in Human Factors and Systems. Yacht is currently enrolled in The University of Texas... Read More →


Wednesday June 20, 2018 2:50pm - 3:40pm CDT
Alamo Ballroom

3:40pm CDT

BREAK- Alamo Ballroom reconfiguration
30-minute break while air walls and technology is configured for breakout sessions

Wednesday June 20, 2018 3:40pm - 4:10pm CDT
N/A

4:10pm CDT

The Why and How of High Reliability Strategies Made Fun and Simple.
While scholarly books and research explaining HRO strategies are readily available, what has not been developed is a simple method for teaching HRO concepts to beginners in a way that is engaging and respects the time constraints pervasive in the modern workplace. 
 
This presentation will be interactive, fun, memorable, and easily re-teachable to others. To achieve this goal, concepts will be presented using animals and simple images that will be re-drawn by participants during the session. 
These images are designed to both convey a concept and trigger HRO behaviors.  Questions that prompt an HRO mindset for will also be presented. 
 
The content will illuminate the 5 strategies of HRO and just as importantly, 5 reasons why they are necessary when performing high-risk work in complex sociotechnical environments.  Understanding the natures of the elements that intersect in complex socio-technical systems:  people, expectations, categories, ambiguity and the unexpected will provide insight into why HRO works.  
 
 
 

Speakers
avatar for Laurin Mooney

Laurin Mooney

Founder, speaking IN and Be Highly Reliable
Laurin is a nurse who has turned her focus from the heath of people to the heath of the employee experience and the critical role it plays in the modern high-risk work environment.  Convinced that High Reliability Organizing holds the keys for success in complexity she translated... Read More →


Wednesday June 20, 2018 4:10pm - 5:00pm CDT
Salon B

4:10pm CDT

Human Performance Improve Activities in JANSI and Fukushima-Daiichi Accident Analysis from Good Practice Viewpoint
 
Human Performance Improve Activities in JANSI  
JANSI assistances for Utility QA activities, such as assistance for the developing Japanese QA standards of JEAC4111 and JEAG4121, which are based on ISO9001 and customized for nuclear facilities according to IAEA GSR-part 2 recommendation. 
Committees are managed by JANSI; 
  • QMS Committee 
   Resolution of common issues on QA by nuclear operators. Consider response policies to issues, share information on overseas QA activities and consider introduction into Japan in pursuit of excellence. 
   ■ Human Factor Committee 
     Reducing human errors and improving human performance. Consider measures for human error reduction, survey activities in other industries, and develop safety awareness posters. Made Human performance improving handbook and held a lecture for that. 
   ■ RCA Committee 
     Improving the effectiveness of Root Cause Analysis (RCA).             RCA training (introduction, skill improvement), case study meetings, create training videos for interviewers. 
 
Fukushima-Daiichi Accident Analysis from Good Practice Viewpoint  
Whereas the direction which discusses the safety from the accident analysis, a new trend of analytical methods such as resilience engineering, high-reliability organization, or risk literacy research, which analyze the various events by focusing on the good practices, are becoming popular. 
Various good cases of resilience response were observed in the individual base and also in the organizational base in Fukushima-Daiichi accident as below: 
  • The effectiveness of insight and of the risk evaluation on accident cases, such as inundations in LeBlayais and Madras plants, and September 11 terrorism and B.5.b.order from US Nuclear Regulatory Commission to keep the plant in safe condition even natural disasters or acts of terrorism occurred, 
  • The decision of continuation of seawater infusion (individual base). 
  • Reflection of the experience on Chuetsu-Oki Earthquake, 
  • Improvement of seismic base isolation building equipped emergency power system and air conditioning system, which was effectively used for emergency response facility (on-site of organizational base), 
  • Deployment of fire engines, which was effectively used for water infusion (on-site of organizational base). 
  • The effectiveness of command system in ordinal time due to training (on-site of organizational base), 
 

Speakers
avatar for Hiroshi UJITA, Ph.D.

Hiroshi UJITA, Ph.D.

Senior Associate Adviser, Plant Operation Analysis Dept, JANSI- Japan Nuclear Safety Institute
He was graduated from Kyushu University, Nuclear Engineering, 1974, and accepted doctor degree from The University of Tokyo, Engineering Research, 1988.   He had been working for Energy Research Laboratory, Hitachi, Ltd. for around 35 years. He was Professor, Tokyo Institute... Read More →


Wednesday June 20, 2018 4:10pm - 5:00pm CDT
Travis

4:10pm CDT

Integrating Human Performance with Lean and Open Book Management
Prior to learning about the “new view” of safety, we had only introduced HPI tools within our organization.  Like many companies, we are also using Lean to drive our continuous improvement efforts and Open Book Management to help employees “think, act and feel” like owners.  As we began exploring more about HPI our company decided to actively shape our culture.  Initially, this was through Senn Delaney’s “unfreezing sessions” and then subsequently followed by Tim Kight’s “Lead Now” and “R-Factor”.  We found that the new view concepts were synergistic with all of these efforts.  Our delivery of human performance fundamentals provided the basis for connecting all of these efforts together allowing them to truly become part of our culture.  Frontline employees were able to see how all of the pieces fit together. 

Speakers
avatar for Drew Seidel

Drew Seidel

VP Distribution Region Operations, Vice President at the Community of Human & Organizational Learning, AEP SWEPCO
Drew Seidel - Vice President Distribution Region Operations for AEP SWEPCO and Vice President of CHOL LearningOver 30 year's experience in the electric power industry in both Generation and Distribution. Currently responsible for the distribution system for SWEPCO's 550,000 customers... Read More →


Wednesday June 20, 2018 4:10pm - 5:00pm CDT
Salon A

4:10pm CDT

Telling the Story Crafting Memorable, Impactful Critical Event Messages
Learning from events and near misses can be a matter of life or death yet the style of our messages has not changed significantly over the years.  We feel powerless when, after modifying procedures and implementing corrective actions, we have a repeat event: it’s a different person at a different plant but not much else is different.  This talk is a practical “how to” craft stories such that important, hard earned lessons are more memorable and more likely to be acted on.  The methods are based in what we can learn from cognitive and marketing sciences.  Specifically, I explore how knowledge of how memories are stored and retrieved and theories in overcoming resistance to persuasion can be used to improve event lessons learned and reporting programs.    

Speakers
avatar for Beth Lay

Beth Lay

Founder and Principal, Applied Resilience, LLC.
An experienced leader who helps develop resilient, reliable organizations. Four years experience as Director of Human Performance at Calpine Corp – an owner/operator of 80+ electric utility power plants. Seven years experience as the leader of Siemens Energy Field Service Risk Management... Read More →


Wednesday June 20, 2018 4:10pm - 5:00pm CDT
Salon D

4:10pm CDT

Common Investigative tools and their integration
This presentation will describe the use of three common investigative tools 
  • change analysis
  •  barrier analysis
  •  events & causal factors charting.

Each tool will be described and an example worked then the results of the three tools will be integrated to demonstrate their value.


Speakers
avatar for Jack Martin

Jack Martin

President Emeritus CHOLearning/VP Consulting, CHOLearning/BackPacker Jack, INC.
Jack is President Emeritus of HPRCT and Vice President of a privately owned business that evaluates and offers suggestions for improvement for corrective action and Human Behavior programs.  He also trains, consults, and mentors high hazard industries in the analysis of significant... Read More →


Wednesday June 20, 2018 4:10pm - 5:00pm CDT
Salon E

4:10pm CDT

Timely Awareness: Simple Tactics for Effectively Inculcating Learnings
Timely Awareness improves human performance. The key is finding ways for the right people to have the right knowledge when they need it – and doing so in a way that conserves resources. This presentation highlights the better techniques from a career of experience. 

In addition, this presentation speaks to human performance at the point of decision and covers a list of tactics from the Oil & Gas industry for adding significant impact to the application of lessons already learned from failure investigations.  Where is the low-hanging fruit?  How can organizations make efficient use of new (and old) knowledge? 

Speakers
avatar for Tim Mullowney

Tim Mullowney

Founder, Petrochor
 Tim is an experienced Process Safety professional whose history in the energy sector began in 1984 in E&P (upstream production, oil field surveying, rigs) and industrial plant construction projects for Exxon, Amoco and others.  In 1991, Mr. Mullowney began work for Conoco (ConocoPhillips/Phillips... Read More →


Wednesday June 20, 2018 4:10pm - 5:00pm CDT
Salon C

4:10pm CDT

Performance Monitoring and Trending Panel Discussion
The purpose of this panel session is to discuss challenges to efficient and accurate performance monitoring, trend analysis program structure/implementation, and implementation of nuclear industry efficiency initiatives.

Key discussion points for the panel include:
  • How individual organization within your company (or if you are a consultant, a company you serve) measures, trends and utilizes identified indicators of concern or interest.
  • How this information used to improve performance.
  • Your company's resource needs to effectively and efficiently monitor performance and identify trends for correction.
  • Challenges organizations face when conducting trending analysis activities.
  • Recommendations/lessons learned for overcoming or working through these challenges.
 The affect recent efficiency initiatives and "Nuclear Promise" has had on your performance monitoring and trending programs.

Moderators
avatar for Joe Estey, Sr.

Joe Estey, Sr.

Senior Performance Improvement Specialist, CHOLearning Director, Lucas Engineering & Management Services
Joe Estey has over 40 years’ experience training and consulting first line workers, foremen, supervisors, department managers and executives in Human Performance Improvement and effective leadership and management principles and practices. He works routinely with forest management... Read More →
avatar for Alex Torres

Alex Torres

Program Administrator- Trend Analysis and Collective Significance Review, Washington River Protection Solutions (WRPS), LLC
Alex Torres was born and raised in Southern California.  In 1980, he enlisted in the United States Navy and served 22 years.  During his military career, he was in the Naval Nuclear Power Program and successfully served in leadership positions in the areas of nuclear operations... Read More →

Wednesday June 20, 2018 4:10pm - 5:00pm CDT
Salon F

5:00pm CDT

HPRCT Board Meeting
Wednesday June 20, 2018 5:00pm - 6:00pm CDT
TBA

6:00pm CDT

HPRCT Evening Reception on the River Terrace & Patio
Come join us on the River Terrace & Patio for a light dinner and refreshments from 6:00-8:00 pm. 

Wednesday June 20, 2018 6:00pm - 8:00pm CDT
River Terrace & Patio
 
Thursday, June 21
 

7:00am CDT

Continental Breakfast
Thursday June 21, 2018 7:00am - 8:00am CDT
Alamo Ballroom

8:00am CDT

Welcome & Logistics- Day 3
Charles Major, President of HPRCT delivers Day 3  remarks

Speakers
avatar for Charles Major

Charles Major

Sr. Director of Operational Excellence and Human Performance at Vistra; President at the Community of Human & Organizational Learning, Luminant
Charles is an alchemist/evangelist/connector by nature and is passionate about big and disruptive ideas to improve the system/human interface and the leadership required to inspire discretionary effort. He leads the Operational Excellence & Human Performance efforts for Vistra; the... Read More →


Thursday June 21, 2018 8:00am - 8:10am CDT
Alamo Ballroom

8:10am CDT

Moving from Managing Human Fallibility to Increasing Human Ingenuity
A number of companies have had a lot of success in managing human fallibility through the philosophy of Human Performance Improvement (HPI).  Some of these same companies are realizing there is another level of success that can be achieved by enhancing the ingenuity of human beings.
Join us is studying how these companies are removing barriers that stand in the way of humans achieving their best performance while still managing human fallibility.  How did a Department of Energy (DOE) laboratory design, 3-D print, and deliver a running Shelby in less than 6 weeks?  How did “Psychology Safety” play a role in a major project coming in one year ahead of schedule and $10 million dollars under budget?

Speakers
avatar for Timothy Bush

Timothy Bush

Owner, Paradigm Human Performance |+Shane Bush
T. Shane Bush is the co-founder of BushCo HPI, Inc. whose primary mission is to “assist companies in eliminating unwanted outcomes related to human error” through the implementation of Human Performance Improvement (HPI). BushCo, Inc. clients include organizations such as Bell... Read More →


Thursday June 21, 2018 8:10am - 9:00am CDT
Alamo Ballroom

9:00am CDT

BREAK
Thursday June 21, 2018 9:00am - 9:10am CDT
N/A

9:10am CDT

Enhancing the Effectiveness of “Learning Groups”: An Approach that Works.
Recent HPRCT Conferences have proposed “Learning Groups” as an alternative approach to evaluating events, establishing causation, and defining corrective actions.  
This presentation addresses key topics necessary to “Learning Group” success, including
  • An effective and proven methodology suitable for use by “Learning Groups” that increases the likelihood of success;
  • A way to transparently document and report the work accomplished by individual “Learning Groups” (required in the US nuclear industry for dispositions of “Significant Conditions Adverse to Quality”);
  • “Red flags” that indicate the event under consideration may be beyond the scope of what is appropriately handled by a “Learning Group”; 
  • The “Blame Game” and how to avoid it; and,
  • A proven technique for avoiding the pitfall of “Group Think.”
 The methodology covered in this presentation is simple, easily memorized, flexible, and suitable for use by groups or individuals.  Participants will be able to apply the content immediately upon presentation completion.

Speakers
avatar for Dick Swanson

Dick Swanson

Founder and President, Performance Management Initiatives, Inc.
Richard N. Swanson, P.E. is the founder and president of Performance Management Initiatives, Inc., a consulting practice that focuses on industrial investigations and performance improvement for high hazard industries, since 1996. Mr. Swanson is the co-editor of The Firebird Forum... Read More →


Thursday June 21, 2018 9:10am - 10:00am CDT
Alamo Ballroom

10:00am CDT

BREAK
Thursday June 21, 2018 10:00am - 10:10am CDT
N/A

10:10am CDT

Principles of Resilience Engineering for Operators of High-Reliability Organizations.
This presentation will provide a general introduction to the underlying concepts of the emerging field of resilience engineering including ideas of adaptive behavior, recursive interactions, planning for flexibility. Of particular interest to HRO operators will be the inclusion of discussions of the similarities and differences between reliability, robustness, and resilience. Attendees should expect to leave with a deeper understanding of resilient system behavior including the recognition of technical definitions and applications of resilience.

Speakers
avatar for Asher Balkin

Asher Balkin

Research Engineer and Laboratory Manager at the Cognitive Systems Engineering Laboratory (C/S/E/L) at Ohio State University, Ohio State University
An interdisciplinary researcher who has worked in fields as diverse as public health, international security, surgical research, and human/automation interaction, Asher is known equally well for the quality of his research as for his sardonic wit. He is currently a Research Engineer... Read More →


Thursday June 21, 2018 10:10am - 11:00am CDT
Alamo Ballroom

11:00am CDT

BREAK
Thursday June 21, 2018 11:00am - 11:10am CDT
N/A

11:10am CDT

How to create a Human Performance Film Festival
The mission was to train over a thousand people over the course of two weeks with only an hour allotted for each session and to make it meaningful. So, when designing training we have to think about these types of constraints. Typical constraints around ROI involve:
  • How many people can you train at once?
  • How long does the training have to be to accomplish the goal?
  • How engaging and inclusive is the training session?
  • Where will it be conducted?
  • Who will develop the content?
  • Is it going to be worth the time and effort put into it?
  • Will the evolution hold up to scrutiny?
Targeted Organizational Goal: Inform contract workforce (close to 50% have never been in a nuclear power plant before)  of human error prevention tools used at a Nuclear power station, and show them how to apply them to prevent errors that could lead to an event.
Financial savings: The class is designed for any qualified instructor to teach, and not specific to the talents of the instructor, where we are sometimes limited.
Ease of instruction: From the instructor’s point of view – Some instructors are not comfortable teaching in such a critical arena, but this class has accessibility and is easy to teach. When the videos are playing, the instructor has time to gather thoughts and prepare for the facilitation between them. Anxiety is almost expected as an instructor in the nuclear training realm, and this class offers little stress to the instructor.
Demonstration of achievement of organizational goal: By using videos created
by the workforce using human error prevention tools, we are able to demonstrate to incoming temporary workers pieces of the culture they are about to work in and reinforce through instruction lessons learned from previous refueling outages.
Time savings: The Film Festival can train up to 60 students at a time
 (only limited by room size), and in previous pre-outage human performance training classes had to be split up with 3-9 students per instructor when conducting any type of activity.

Seven original videos were created by the workforce to be used in a film-festival DLA with the intent of showing incoming refuel-outage contractors HU error prevention tools used as Wolf Creek, and how to use them. The video content had to meet specific criteria, including which tool they were showing, length, and why their department values that particular tool. Students walk into a movie theater environment with chairs placed with one major aisle
down the middle with floor and chair labels to match the ticket number what students get on the way in.  They are greeted by an usher over a small red carpet and a leather rope with stanchions to be allowed into the theater - they get their name added to the attendance list on a clipboard and they receive their ballot and seat ticket (which they need to get peer checked).  The smell of popcorn permeates the air, as attendants are waiting for students to follow the ballot steps and order popcorn using three-way communication as directed in the ballot.  The training leads off with an introduction video followed by a safety video reminding to not drive while talking on a phone and to not walk and text.  Wolf Creek employees were excited to participate in making these videos from the concepts to the acting to the editing; the process was engaging and fun for the workers, as they were reminded how important error-prevention tools are in our workplace.  Each video was designed to show common situations contractors may find themselves in and how to use the pertinent HU tool to be successful.
Students participate using five HU tools within the training activity, including:
• Self-checking your name on the attendance sheet
• Peer-checking someone else is in the correct seat and getting a peer check to ensure you are in the correct seat
• Using Three-Way Communication to order popcorn
• Participating in a Pre-Job Brief prior to grading the videos
• Place-keeping the videos in the Ballot/Program
 The training is very inclusive and engaging on a large scale. Greater than 95% of students (Over 1000 students) indicated with comments that they prefer this type of training and that it helped them understand human performance error-prevention tools better. This training has Affective elements that are typically missing from nuclear training. The videos and the instruction offered why using error-reduction tools should be valued by the students, and not just by telling them, but by showing them.

Speakers
avatar for James Newman

James Newman

Human Performance Improvement Program Manager, Lawrence Berkeley National Laboratory
As a practitioner, James leverages his instrument & controls and nuclear power industry background to attack problems and develop realistic and applicable solutions.  He has developed solid leadership work observation programs and training used in commercial power generation and... Read More →


Thursday June 21, 2018 11:10am - 12:00pm CDT
Alamo Ballroom

12:00pm CDT

Lunch
Thursday June 21, 2018 12:00pm - 1:00pm CDT
River Terrace

1:00pm CDT

Cultural Analysis and Corrective Action for Positive Transformational Performance
To illustrate through multiple case studies, the value of using preventative latent analysis of people and culture to obtain positive leadership and high performance.

The author has led multiple investigations involving cultural root causes.  Two case studies will be presented where cultural corrective action was used to transform performance with remarkable results.
A cryogenic gas processing plant had experienced an increase in unplanned human-caused shutdowns.  Leadership believed the shutdowns were indicative of larger cultural issues that would eventually lead to a severe incident.  Using Latent Cause Analysis, people evidence was collected from interviews to establish the as-is culture.  Leadership was involved in addressing anonymous as-is culture and shaping as-desired behaviors and cultural corrective actions, in a positive, transparent delivery.  Performance and general culture improved dramatically.  The plant subsequently shattered all prior records for unplanned outages.
Recently acquired oil and gas production operations had suffered from toxic leadership that led to a lack of established positive safety culture.  Safety performance was the worst for any asset within the organization.  A cultural assessment was performed using Latent Cause Analysis methods coupled with transformational leadership problem-solving.  Cultural corrective action was implemented.  The asset performed incident free for two years.
The methodology for both investigations will be shared along with lessons learned from other cultural investigations that produced lasting results.

Speakers
avatar for Paul Espenan

Paul Espenan

Vice President of Environmental, Health, and Safety, LINN Energy
Mr. Paul Espenan has been actively changing lives for over 30 years.Mr. Espenan graduated from Louisiana State University with a degree in Environmental Health, and the University of Texas at Dallas with a Master’s degree in Environmental Science.  Paul began his professional career... Read More →


Thursday June 21, 2018 1:00pm - 1:50pm CDT
Alamo Ballroom

1:50pm CDT

BREAK
Thursday June 21, 2018 1:50pm - 2:05pm CDT
N/A

2:05pm CDT

Innovation 4.0 using agile problem solving to develop disruptive new products
Give participants an overview of a new concept in Innovation that utilizes agile problem solving and decision making to get insights into next-generation new products that will disrupt your market.

 KT’s Agile Problem-Solving for Innovation-

Agile Problem-Solving is different for concept design.  You only know the solution when you get the do the problem and solution together-Agile problem-solving.  Causality is developed as we go.  Designing a product that never existed.  Growth requires innovation which requires problem-solving for growth….new data)  Should we use JD Power for growth data…….or we go to  Insight and work with the implementation.KT’s Agile Problem-Solving replicates what QFD has done to improve Quality … to now fix Innovation & Growth.







Speakers
avatar for Michael

Michael

Senior Principal, Kepner-Tregoe
Senior Principal who  manages global practice  Experienced, hands-on, global consulting Leader with years of experience providing strategy consulting and operational improvement consulting to the C Suite, senior leadership and plant leadership. Currently serves in the areas of strategy... Read More →


Thursday June 21, 2018 2:05pm - 2:55pm CDT
Alamo Ballroom

2:55pm CDT

BREAK
Thursday June 21, 2018 2:55pm - 3:10pm CDT
N/A

3:10pm CDT

Session Title Speak Up: Unconsciously Reinforcing the Hierarchy
Effective sensemaking in ambiguous situations and accurate and timely feedback are essential processes of High Reliability Organizing.
The problem of people not “speaking up” during sensemaking processes and providing feedback necessary for updating persists across all industries, especially healthcare, despite interventions to promote the behavior.
“The Joint Commission predicted that 80 % of the serious safety events occur due to miscommunications among healthcare professionals. Speaking up is one of the critical behaviors of patient safety that displays an important role for improving quality and patient safety in healthcare (Ahmet Nacioglu, 2016).”
“Ineffective communication is one of the most frequently identified root causes of sentinel events and contributes to the 400,000 deaths that occur each year due to preventable medical errors (Palatnik, 2016). Ineffective communication includes failure of staff to speak up when they know something is wrong that could potentially cause harm to the patient (Palatnik, 2016).”
Despite the many initiatives implemented in the last decade encouraging staff members to speak up for patient safety, many staff are still reluctant to to speak up. There are many influencing factors cited for staff unwillingness to speak up including fear of retaliation and fear of appearing incompetent.
However, we posit that the problem is perpetuated by the current model in which the solution to the problem is to “speak up.”
Therefore we propose the new model “speak in.” This model reframes ideas related to social structures, responsibility, purpose, and meaning of speaking and shifts influencing factors in a way that will drive increased communication and improve outcomes.

Speakers
avatar for Laurin Mooney

Laurin Mooney

Founder, speaking IN and Be Highly Reliable
Laurin is a nurse who has turned her focus from the heath of people to the heath of the employee experience and the critical role it plays in the modern high-risk work environment.  Convinced that High Reliability Organizing holds the keys for success in complexity she translated... Read More →
avatar for Renaldo Blocker, Ph.D.

Renaldo Blocker, Ph.D.

Associate Consultant and Assistant Professor, Mayo Clinic, Robert D. and Patricia E. Kerns Center for the Science of Health Care Delivery
Dr. Renaldo C. Blocker is an Associate Consultant and Assistant Professor in the Department of Health Sciences Research and in the Mayo Clinic Center for the Science of Health Care Delivery Healthcare Systems Engineering Department. Dr. Blocker is the Associate Scientific Director... Read More →


Thursday June 21, 2018 3:10pm - 4:00pm CDT
Salon B

3:10pm CDT

Identifying Human Error in Safety Critical Tasks: Tool Development and Testing
This presentation will discuss the development of a Safety Critical Task Analysis (SCTA) tool used to identify opportunities for human error and its benefits. It will also describe the successful collaboration between BP and BHGE in the development, testing, and implementation of the tool in different work processes.

In recent years, safety leaders have focused attention on systemic issues that can contribute to human error when completing tasks. Reduction of error traps and implementation of strong defenses play an important role in today’s view of on-the-job safety. Having strong barriers is especially important where there are safety-critical tasks. With that in mind, BP developed a tool to identify error traps and expose potential for barrier failure in collaboration with BHGE.  The team tested the tool across multiple activities including mud logging and directional drilling operations. The tool’s main objectives are to:
  • Identify the possible human errors during the Critical Task
  • Identify which of those errors can lead to the Critical Task failing, leading to a failure of the barrier based on safeguard and mitigations in place. 
  • Assess the risk associated with the error.
  • Identify ways to eliminate error traps and strengthen barriers.


Speakers
avatar for Sarah Acton

Sarah Acton

Human Factors Lead, Baker Hughes
Sarah Acton bio- Sarah Acton has a BS degree in Industrial/Organizational Psychology and an MA in Human Factors Engineering. Ms. Acton has nearly 20 years of experience working with various aspects of human behavior and performance in safety-critical environments. She has spent her... Read More →
avatar for Chris Parker

Chris Parker

Senior Human Factors Consultant, BP
Mr. Parker is an internationally recognized Human Factors Engineer and Ergonomist. He is educated and practiced in the application and integration of Human Factors Engineering (HFE) and related disciplines for both commercial and government clients for over 20 years. Mr. Parker began... Read More →


Thursday June 21, 2018 3:10pm - 4:00pm CDT
Salon E

3:10pm CDT

Looking for Human Error? Then make it human & lose the "big stick"
Human performance holds great promise for improving safety and reducing SIFS (Serious Injuries & Fatalities).  In this session, we explore how easy it is for people to judge other people’s instinctive decisions, rather than exploring the context in which those decisions were made AND without using "the big stick approach".  Change how you view the world of behaviors, their contexts and how we interpret and learn from them.   
 
The purpose of analyzing the human behavioral component of any event is to understand why those involved did the things they did. Investigations attempt to understand the workplace conditions, worker attitudes, adequacy of staffing levels, and the effectiveness of leadership in order to explain what happened.  This presentation seeks to understand how worker’s decisions and the capacity of the organizational management system to influence of safe and at-risk behaviors make sense at the time, given the environment within which they were working.    
When we incorporate elements of Human and Organizational Performance (HOP) and Behavior-Based Safety (BBS) into the investigation it allows management to create an environment where workers can make good decisions by recognizing the role of the individual and human fallibility, identifying how organizational systems influence human behavior and embracing the role of the leader to manage organizational systems in order to positively influence human behavior.  Further, as worker behaviors are examined using the behavioral approach, the underlying & well-hidden management system at risk behaviors become apparent. When we reach these holistic conclusions, we can concentrate on improving the management system....instead of using the easy answer of the "big stick".  This blended approach allows us to become an advocate for the most precious resource we have – the worker. 
 
 

Speakers
avatar for Tom Courtney

Tom Courtney

EHS Leader, GE Appliances- Appliance Park
Tom Courtney is currently the EHS Leader for GE Appliances at Appliance Park where he oversees a workforce of over 6000 union and salaried workers making the world’s best appliances. He is a Certified Safety Professional, a Certified Human Performance Practitioner, and a member... Read More →
avatar for Bill Sims

Bill Sims

President, The Bill Sims Company
Bill Sims Jr. is the President of The Bill Sims Company.  Since 1959 The Bill Sims Company has been helping companies improve performance and increase bottom line profits. We design and administer awareness and reward systems using leading indicators of safety, quality, and production... Read More →


Thursday June 21, 2018 3:10pm - 4:00pm CDT
Travis

3:10pm CDT

Moving from Managing Human Fallibility to Increasing Human Ingenuity
A number of companies have had a lot of success in managing human fallibility through the philosophy of Human Performance Improvement (HPI).  Some of these same companies are realizing there is another level of success that can be achieved by enhancing the ingenuity of human beings.
Join us is studying how these companies are removing barriers that stand in the way of humans achieving their best performance while still managing human fallibility.  How did a Department of Energy (DOE) laboratory design, 3-D print, and deliver a running Shelby in less than 6 weeks?  How did “Psychology Safety” play a role in a major project coming in one year ahead of schedule and $10 million dollars under budget?

Speakers
avatar for Timothy Bush

Timothy Bush

Owner, Paradigm Human Performance |+Shane Bush
T. Shane Bush is the co-founder of BushCo HPI, Inc. whose primary mission is to “assist companies in eliminating unwanted outcomes related to human error” through the implementation of Human Performance Improvement (HPI). BushCo, Inc. clients include organizations such as Bell... Read More →


Thursday June 21, 2018 3:10pm - 4:00pm CDT
Salon A

3:10pm CDT

HELP (Holistic Event Learning Process): The Love Child of Learning Teams and the Latent Cause Analysis Process
Like Chocolate and Peanut Butter, Batman and Robin, Laverne and Shirley, and Starsky and Hutch, many good things in life are made great when combined with something else that is good, but a little different. That’s the case with Learning Teams and the Latent Cause Analysis process.
 This course will highlight the differences and strengths of each process and provide a framework for how the processes can be combined to create a truly magnificent Holistic Event Learning Process (HELP).

Speakers
avatar for Wes Havard

Wes Havard

OE Senior Consultant, Luminant
I was born at an early age, but I got older. After being accidentally left outside an all-you-can-eat barbecue joint outside Uncertain, Tx, I was adopted by a small family of Sasquatch. Eventually I made my way to the Martin Lake Power Plant where I was adopted by a family of OEs... Read More →


Thursday June 21, 2018 3:10pm - 4:00pm CDT
Salon C

3:10pm CDT

Learning to Lead Learning Teams: A Simple And Practical Approach to Facilitated Learning
Provide the participant with a practical approach and the necessary background to effectively lead a Learning Team.

Learning Teams have been a recent and much welcome addition to the cause analysis process. In this 50-minute presentation, Ron Farris will introduce one possible approach to Learning Teams that is both practical in nature and repeatable.  This presentation will introduce the participants to the fundamentals of facilitated learning. Participants will also have an opportunity to discuss the method proposed and possible short falls that can impede learning when facilitating Learning Teams.
The primary objective of the Learning Teams is to recreate the mindsets of those involved in the event by bringing those individuals who were closest to the event together to learn from the event in a non-punitive environment. It is also important that the facilitator seek to understand the environment the individuals found themselves in at the time, that most likely influenced their decision-making process. In other words, “why” the actions of the individuals made sense to them at the time, without asking “why”.  With this new approach, the Learning Team Facilitators will be encouraged to recreate the decision-making environment to contextualize the decisions and behaviors that lead up to the event.  It is extremely important to obtain a meaningful understanding of these decisions and behaviors and ultimately how they influenced the undesired outcome.  Fully understanding and appreciating context is the hallmark of a successful Learning Team and to providing lessons to be learned to prevent recurrence.

Speakers
avatar for Ronald

Ronald

COO of High Reliability Training (HRT), Inc., HRT
Ron is an author, keynote speaker, and a human and organizational performance specialist, principal consultant and business partner of HOPE Consulting and COO at High Reliability Training, Inc. Ron served eight years on active duty in the U.S. Navy nuclear program. While on active... Read More →


Thursday June 21, 2018 3:10pm - 4:00pm CDT
Salon D

3:10pm CDT

Trend Analysis as an Input to Your Safety Culture Monitoring Process
The purpose of this presentation is to communicate the alignment between safety culture attributes and trend/cause codes and leveraging this relationship to assess culture and identify actionable recommendations for improvement.

As discussed in NEI 09-07, Fostering a Healthy Nuclear Safety Culture, the Corrective Action Process (CAP) is the largest single source of potential input to the culture monitoring process. Site performance trends are an input to the culture monitoring process, and the examination and communication of organizational trends are part of a healthy safety culture as specified in DOE G 450.4-1C, "Integrated Safety Management System Guide." As such, Washington River Protection Solutions (WRPS) evaluates causal factors associated with performance trends and individual issues and aligns these factors where appropriate to Safety Culture Focus Areas and Associated Attributes, Integrated Safety Management System (ISMS) expectations, and human performance error precursors. From this analysis, overarching focus areas are identified for use as management awareness areas during the conduct of day-to-day business for performance improvement.

Speakers
avatar for Alex Torres

Alex Torres

Program Administrator- Trend Analysis and Collective Significance Review, Washington River Protection Solutions (WRPS), LLC
Alex Torres was born and raised in Southern California.  In 1980, he enlisted in the United States Navy and served 22 years.  During his military career, he was in the Naval Nuclear Power Program and successfully served in leadership positions in the areas of nuclear operations... Read More →


Thursday June 21, 2018 3:10pm - 4:00pm CDT
Salon F

4:00pm CDT

BREAK
Thursday June 21, 2018 4:00pm - 4:10pm CDT
N/A

4:10pm CDT

Case Study – Becoming a Learning Organization in the Oil Patch -
The purpose of this breakout is to provide a case study on how a field organization including production operations and Drilling and Completions can make a cultural shift to a learning organization that embraces Human Performance principles

The Eagle Ford team has been an early adopter of Human Performance and Learning Teams within COP. Since 2014, there has been an on-going effort to become a Learning Organization that embraces Human Performance principles.  Although the organization will not claim it has become a learning organization, it does have many characteristics suggesting a significant cultural and organizational change has occurred.  Below is a draft agenda
Agenda
  • Background – How do we define a learning organization?
  • What are the key focus areas to support the transformation?
  • What specifically have you done to drive the cultural shift? (examples of learning teams, crucial conversations with leadership and management)
  • What challenges and pitfalls have been overcome?
  • What is next on the journey?


Speakers
avatar for Eric Fransen

Eric Fransen

Operations Support Superintendent L48 D&C Operations, ConocoPhillips
Eric Fransen is Gulf Coast Business Unit Drilling & Completion Operations Support Superintendent for ConocoPhillips.  He is based in Kenedy, Texas and supports Eagle Ford and Central Louisiana Drilling and Completion operations.Eric joined Conoco in 1982 in Corpus Christi Texas.  He has held various field leadership roles in ConocoPhillips’ L48 Production Operations and Drilling & Completion Organizations.Eric is a member of the ConocoPhillips Gulf Coast Business Unit Human Performance Implementation... Read More →
avatar for Scott Weaver

Scott Weaver

Senior Advisor- Human Performance and Assurance, ConocoPhillips
Scott Weaver has been with ConocoPhillips for 27 years and recently moved into the role of Senior Advisor of Human Performance and Assurance in the Lower 48 Health Safety and Environment group. Scott has had various technical and leadership roles in Engineering, Capital Projects and... Read More →


Thursday June 21, 2018 4:10pm - 5:00pm CDT
Salon E

4:10pm CDT

How to Influence Across Generations
One of the loudest conversations currently taking place in Leadership and Performance Improvement space is- how to deal with different generations in the workforce, especially Millennials.  
Thirteen years of PPI experience working with tens of thousands of workers and their leaders around the globe have validated that all human beings have a core set of intrinsic characteristics- whether born in 1925 or 2001 (or anywhere in between).
The Millennial Generation has received a great deal of ‘press’ because (1) it is the largest generation ever, and (2) the ‘worldview’ of the members of this generation can be quite different from the Traditionalists, Boomers, and Xers.
Taking what in many organizations is four generations of workers and attempting to achieve a “one team” approach has proven a great challenge to many.  This is because of an acute focus on differences and the “sticking points” they create.
When the focus is placed on the intrinsic elements of what makes us “human”, these differences can be a blessing rather than a curse.
In this breakout session, participants will:
  • Understand the results of their personal IQ (Influencer Quotient™), and how to leverage their individual preferences/biases to maximize their personal ability to influence
  • Be introduced to a simple model of INFLUENCE
  • Understand that the intrinsic needs and desires of all generations are essentially the same
  • Recognize that out of ten core values, eight are the same across all generations
  • Learn how to positively leverage the two values where Millennials differ from the three earlier generations
  • Be given tangible “how to” insight into how influence across all generations, melding personal IQ with the simple model of INFLUENCE

Speakers
avatar for Stacey Hefner

Stacey Hefner

Vice President – Utilities and Contractor Services, Practicing Perfection Institute, Inc.
Stacey L. Hefner (PPC)Vice President – Utilities and Contractor ServicesStacey.hefner@ppiweb.comDirect: (512)215-4045Cell: (512)567-4542Stacey Hefner has spent the majority of her professional career in the safety and health field with the past nine years focused on Human Performance.She has a Bachelor of Science Degree from Texas State University and has her PPM/PPC/ HP ce... Read More →


Thursday June 21, 2018 4:10pm - 5:00pm CDT
Salon F

4:10pm CDT

Learning to Deal with Drift
The purpose of this session is to introduce attendees to the concept of organizational drift, its causes, and opportunities to manage organizational drift, based on the presenter’s research.

Summary:
Organizational drift, sometimes called “drift into failure,” “practical drift,” or “normalization of deviance, has been implicated in numerous accidents and disasters in the past two decades, from the NASA shuttle disasters to Deepwater Horizon, to even aspects of the recent financial meltdown. But what is drift and what can organizations do about it? This presentation will discuss the processes that enable organizational drift and provide attendees with the latest research on how to identify and manage drift to not only avoid accidents but also to enable successful performance.
Learning objectives:
  • Define organizational drift.
  • Review case studies where organizational drift has been identified.
  • Identify the challenges and opportunities in identifying organizational drift in attendees’ workplaces.
  • List methods to avoid drift into failure and enable a drift into success.

Speakers
avatar for Ron Gantt

Ron Gantt

Vice President, Safety Compliance Management, Inc.
Ron Gantt is a management consultant with Reflect Consulting Group. He has 17 years experience in safety management in industries such as construction, utilities, and petrochemical, as well as others. Ron has a master degree in advanced safety engineering and management, as well as... Read More →


Thursday June 21, 2018 4:10pm - 5:00pm CDT
Travis

4:10pm CDT

People Based Quality – An interactive case study of our efforts to proactively affect quality.
This presentation will introduce People Based Quality (PBQ) as it is being used on our various projects.

The Bechtel Quality department has developed an approach to address quality “error likely situations”.  We have a two-pronged approach to account for both manual and non-manual work situations.  The program is based on our 5 Quality Absolutes and proactively affects quality outcomes using a foundation of HU (HPI) tools and approaches. We believe that re-work includes re-hazards and directly affects our safety outcomes. Our experience has been that this approach definitely reduces rework and that it is well received by both supervision and line workers. Where we usually have to “push” our programs, this approach is actually creating “pulls” from the various organizations because it identifies knowledge and performance gaps prior to the work and closes those gaps before work begins. The presentation will include an audience participation portion to show PBQ in action.

Speakers
avatar for Tim Staton

Tim Staton

Human Performance Improvement Specialist, Bechtel Corporation
Tim Staton is the Human Performance Improvement Specialist at the Bechtel led Joint Venture to destroy the last of the nation’s stockpile of chemical weapons in Richmond, KY


Thursday June 21, 2018 4:10pm - 5:00pm CDT
Salon A

4:10pm CDT

A Practical Approach to Recognizing Risk and Preventing Events through Organizational Learning
The presentation will introduce practical methods Richard has used to understand why events occurred and develop a report that management can use to make rational decisions on the “real” causes of events.  The methodology uses the work of Sydney Decker and James Reason, with whom most experienced practitioners are familiar, and the concepts of cognitive investigation (Ron Fisher, Florida Atlantic University) to present the decisions and factors that led to an event.
The basic precepts of the methodology are aligned with these principles:
  • People do what they THINK their boss wants them to do
  • People do what they do because they think it is the right thing to do at the time
  • Events don’t just happen – they are the result of good people placed in challenging situations
  • Organizations and individual tend to underestimate the risk of an event occurring based on their past successes
  • The people involved in the event have the best idea of why they did what they did and what they could do differently next time
  • Unless you can make management understand these principles, you can’t expect them to make substantive change
This presentation will expend on the principles above and introduce the attendees to a methodology used to investigate events and provide management an understanding of why the event really occurred.  Rather than a complex Root Cause or other formal cause analysis, which is still appropriate for some events, the methodology recommended in the presentation is a practical method that a new or experienced practitioner can use to engage all levels of the organization in the learning process.
 Richard will provide the participants a method that helps identify how organizational weaknesses contributed to the event and the need to develop SMART corrective actions to prevent recurrence. Even when using formal cause analysis techniques, the engagement of the participants in an event can help to formulate simpler and more effective corrective actions.  In many cases, addressing issues at the “learning opportunity” level will prevent more significant events.

Speakers
avatar for Richard Cole, Ed.D.

Richard Cole, Ed.D.

Human and Organizational Performance Specialist, Hope Consulting, LLC.
Richard (Dick) Cole, CPT, Ed.D. – HOPE Consulting LLC, Human and Organizational Performance Specialist; R C Consulting, Principal: Certified Performance Technologist                                                With over 40 years of experience in government... Read More →


Thursday June 21, 2018 4:10pm - 5:00pm CDT
Salon D

4:10pm CDT

How NOT To Cause a Catastrophe
The purpose of this breakout is to demonstrate an IDEA about how to help people learn about their own detrimental tendencies before they end-up a catastrophe via hands-on audience participation. 


A means has been established to introduce everyone in an organization to an inexpensive and non-threatening way to learn about their own detrimental tendencies BEFORE they end-up causing a disaster. 
 
Attendees will be asked to imagine themselves back at work, pretending they have been asked to attend a 50-minute session about how to learn from things that go wrong BEFORE a major incident. 
 
Attendees will then be exposed to a few, short Video Scribe presentations – lively and to the point, after which they will be asked to participate in a group discussion, and finally, each will be asked to perform an actual exercise to demonstrate the technique. 
 
FULL DISCLOSURE NOTE:  this presentation will be introducing a new Failsafe product called IntroSpect.  It will NOT be a sales pitch, but an interactive session designed to 1) show attendees the value of personal introspection and 2) get feedback on the approach. 
 

Speakers
avatar for C.ROBERT

C.ROBERT

Founder/CEO, Failsafe-Network
C. Robert Nelms is a degreed Aerospace Engineer, having graduated from Texas A&M University in 1970. He worked at McDonnell Douglas until 1973, then became employed at Allied Chemical’s Nylon plant in Chesterfield, Virginia --an internationally recognized leader in Manufacturing... Read More →


Thursday June 21, 2018 4:10pm - 5:00pm CDT
Salon C

5:00pm CDT

HPRCT Member Meeting- Closing Conference Session
Member Meeting closing the 24th Annual HPRCT Conference. All conference attendees are invited and encouraged to attend this meeting.

Thursday June 21, 2018 5:00pm - 6:00pm CDT
TBA
 
Friday, June 22
 

7:00am CDT

Continental Breakfast
Friday June 22, 2018 7:00am - 8:00am CDT
TBA

8:00am CDT

Staff Rides (Highly Reliable Organizing Event Analysis)
Staff Rides, also called Event Analyses, originated in the Army and are a way to look at an event from multiple perspectives.  They provide a window into an organization through the idea that minor deviations, surprises, mistakes and recurring problems often reveal much about the state of the system.   In this workshop, we involve participants in an interactive demonstration of the Staff Ride process.  We begin with a discussion of using open-ended questioning, with HRO framing, to explore an event.  Then participants practice by questioning people, in different roles, who involved in an event, around an “interview carousel”.  We wrap up by coming back together and noticing that interpretations of what happened varies based on where people start in the interview carousel (1st interview shapes their line of questioning) and we share how observations can be assessed against a “mindful” maturity model to identify areas for improvement, referencing a “mindful” maturity model designed by Annette Gebauer gebauer@icl-net.de and Bert Slagmolen Bert.slagmolen@A13c.nl

Speakers
avatar for Beth Lay

Beth Lay

Founder and Principal, Applied Resilience, LLC.
An experienced leader who helps develop resilient, reliable organizations. Four years experience as Director of Human Performance at Calpine Corp – an owner/operator of 80+ electric utility power plants. Seven years experience as the leader of Siemens Energy Field Service Risk Management... Read More →
avatar for Laurin Mooney

Laurin Mooney

Founder, speaking IN and Be Highly Reliable
Laurin is a nurse who has turned her focus from the heath of people to the heath of the employee experience and the critical role it plays in the modern high-risk work environment.  Convinced that High Reliability Organizing holds the keys for success in complexity she translated... Read More →


Friday June 22, 2018 8:00am - 12:00pm CDT
TBA

8:00am CDT

Green Beans & Ice Cream: The Recipe for a Culture of Commitment
During this presentation, Leaders will be introduced to how to model positive behavior and they will be provided tools to help learn to design and implement successful behavior-based talent retention and recognition programs so that a corporate culture that focuses on achieving long-term performance improvements, eliminating favoritism, and engaging the middle manager thus resulting in higher profits for the shareholders. Participants will learn the benefits of proactive programs and will explore the most “popular” recognition tools in use today and what the latest studies indicate about their effectiveness. 

It’s a business no-brainer that happy employees make better employees.  
 
But how do you get happy employees that deliver their best work on a consistent basis? 
 
And how do you create a Culture of Commitment in your organization? Further, how do you shift your workplace culture from “I have to do it or I’ll be in trouble” to “I want to do it because I believe in it”? Based on Bill’s best-selling book: “Green Beans & Ice Cream: The Remarkable Power of Positive Reinforcement”, this presentation explores how R+ Leadership ensures that your employees perform at their best. Not only will R+ Leadership attract and retain high-performance employees, it will also produce rapid performance improvement among low-performer employees. We will focus extensively on the mechanisms needed for successful behavior-based processes and consider areas that are often overlooked. 
Learning Outcomes: 
 
•             Learn the definition of Positive Reinforcement and how it improves culture, safety, quality, and customer service. 
•             Determine what types of employees you have: compliant, non-compliant or committed, and what drives each type 
•             Learn how positive reinforcement drives commitment and employee engagement, which translate to improved profits! 
  

Speakers
avatar for Bill Sims

Bill Sims

President, The Bill Sims Company
Bill Sims Jr. is the President of The Bill Sims Company.  Since 1959 The Bill Sims Company has been helping companies improve performance and increase bottom line profits. We design and administer awareness and reward systems using leading indicators of safety, quality, and production... Read More →


Friday June 22, 2018 8:00am - 12:00pm CDT
TBA

8:00am CDT

Safety Differently- A New View of Safety Excellence
This session is designed to provide an overview of the tenets of Safety Differently, including redefining how safety is defined, the role of people in the organization, and the focus of the organizations with respect to safety management. 

Current safety management approaches are based on outdated models of organizational management and human performance, some over 100 years old. No wonder while the world changes ever more rapidly, the safety profession is seeing diminishing returns for our efforts. Yet, we continue to press ahead, doing what we’ve always done, and getting what we’ve always gotten.  
 
This session will introduce a new model of safety management – Safety Differently. Based on decades of research and practice in high-risk industries, Safety Differently provides a new way to approach safety problems and a new set of tools for the safety professional. It is based on three basic tenets that contrast with traditional approaches to managing safety:  
 
  1. Safety is defined by its presence (not its absence) 
  1. People are the solution (not a problem to control) 
  1. Safety is a top-down ethical responsibility (not a bureaucratic accountability to those at the top) 
 

Speakers
avatar for Ron Gantt

Ron Gantt

Vice President, Safety Compliance Management, Inc.
Ron Gantt is a management consultant with Reflect Consulting Group. He has 17 years experience in safety management in industries such as construction, utilities, and petrochemical, as well as others. Ron has a master degree in advanced safety engineering and management, as well as... Read More →


Friday June 22, 2018 8:00am - 12:00pm CDT
TBA

8:00am CDT

Clean Interviewing: Keeping Your Stuff Out and Gathering Their Stuff In
To investigate how the wording of interview questions can unintentionally and unknowingly bias answers, how ‘leading’ questions cast doubt on the authenticity of the data collected, and how you can avoid this by asking ‘clean’ questions. 
 
The aim of this workshop is for you to learn and integrate the principles of Clean Interviewing and to develop your ability to design and frame clean questions during practice interviews. You will learn how to interview using Clean Language so your interviewees are given maximum opportunity to provide reliable information ‘uncontaminated’ by an interviewer’s framing, presuppositions, and metaphors.  
 
You will also learn a new process for validating the ‘cleanness’ of an interview thereby increasing the robustness of your methodology.  
 
Interview technique is vital in a number of research areas. However, the value of the data gathered depends on the quality of questions asked. 
 

Problem  
 
Because asking questions is so common, interviewers can be lulled into believing that interviewing is unproblematic and requires little specialist knowledge. Empirical research shows, however, that even a single word (especially a metaphor) or presupposition can materially ‘lead the witness’.  
 
Interviewee answers may then be subject to the ‘consistency effect’, the ‘acquiescence bias’, and the ‘friendliness effect’ (Podsakoff, MacKenzie & Podsakoff, 2003). Added to this, the potential for ‘priming’ and ‘confirmation bias’ by the interviewer (Oswald & Grosjean, 2004), can result in a low ‘signal to noise’ ratio at best, and compromised validity at worst.  
 
Solution  
 
Clean Interviewing, an application of Clean Language (Grove & Panzer, 1989), reduces unintended interviewer bias and protects the integrity of interviewee information. Clean questions keep interviewees focused on the research topic without restricting or leading them. It also provides a method for validating the authenticity of the data collected using a ‘cleanness’ rating (Lawley & Linder-Pelz, 2016). This is the only quantitative validity rating of its kind within both causal and academic interview methods.  
  
Aims & Outcomes  
 
The workshop will provide the research base and practical activities for participants to learn:  
 
(1) how bias is unintentionally introduced into an interview 
 
(2) how to use classically clean questions 
 
(3) how to construct contextually clean questions which maximize the collection of relevant information 
 
(4) how to use a cleanness rating instrument to assess the authenticity of the data collected.  
 
 
 
 
Skills & Activities  
 
Participants will:  
 
  • Learn to distinguish between clean and leading questions based on real interview excerpts, allowing them to expand beyond ‘open-closed’ question framework previously learned.  
 
  • Experience the felt difference between answering clean questions and those containing leading presuppositions and metaphors.  
     
  • Learn and practice interviewing using clean questions.  
     
  • Learn and practice using the cleanness rating instrument. 
 

Speakers
avatar for Sharon Small

Sharon Small

Clean Language Facilitator and Trainer, The Clean Language Institute
Sharon Small is an independent researcher and internationally recognized Clean Language trainer and assessor. She has over 13 years of experience working in the nuclear industry, a degree in psychology, and background in NLP. She is the author of The End of Therapy, co-editor of... Read More →


Friday June 22, 2018 8:00am - 5:00pm CDT
TBA

8:00am CDT

Establishing The Causes of Events: Methods and Techniques for Learning Groups and Causal Analysts
 This eight-hour workshop will present a plain English approach to determining the causes of events based on ordinary logic and proven analytical techniques that may be applied in concert with any other causal methodology currently in use.  

Workshop content is directly relevant to “Learning Group” members, causal analysts, and those who review, approve and use their outputs.  After completing the workshop, participants will be able to apply the learning in their next day at work.

Appropriate emphasis is placed on: (1) why assigning “Blame” is inappropriate for causal analysis efforts of any kind; (2) why “Blame” is a ‘red flag’ indicating a seriously flawed analysis; and (3) how to avoid participating in the “Blame Game.”

This workshop is presented as a case study.

A number of specific analytical tools are also presented. Following descriptions of each tool, participants engage in group discussions and hands-on exercises that internalize the subject matter.
Appropriate emphasis is placed on: (1) why assigning “Blame” is inappropriate for causal analysis efforts of any kind; (2) why “Blame” is a ‘red flag’ indicating a seriously flawed analysis; and (3) how to avoid participating in the “Blame Game.”
The event scenario and background material are provided as the training unfolds throughout the day.

This workshop is for professionals whose current or near-term future duties involve:
  • Dealing with the impact of consequential organizational events.
  • Sponsoring, leading, supporting, or reviewing the output of Learning Groups assigned to analyze adverse events.
  • Sponsoring, conducting, or reviewing root cause analyses of adverse events or their precursors.
  • Managing or training event investigation teams of any variety.
  • Assessing the effectiveness of event investigations.
  • Managing the outcomes of event investigations.
  • Managing or assessing corrective action programs.
 Defending the regulatory aspects of event investigations

This workshop is not for people who want to continue thinking that:
  • Future events can be entirely prevented through increased focus on “Human Performance” and “Trending.”
  • Causal Analysis is an appropriate tool for assigning blame.
  • “Root Cause” is “Old Thinking” that is no longer valid.
  • The use of “Learning Groups” is a fad that is not a valid investigatory approach.
  • Event investigation is a well-defined science about which nothing new can be learned.
  • There is a single right way to investigate events.
  • For every consequential event there is one single root cause.
  • Event consequences are not controlled by business decisions.
  • Event investigation should be done mainly to satisfy outside agencies

Speakers
avatar for Dick Swanson

Dick Swanson

Founder and President, Performance Management Initiatives, Inc.
Richard N. Swanson, P.E. is the founder and president of Performance Management Initiatives, Inc., a consulting practice that focuses on industrial investigations and performance improvement for high hazard industries, since 1996. Mr. Swanson is the co-editor of The Firebird Forum... Read More →


Friday June 22, 2018 8:00am - 5:00pm CDT
TBA

12:00pm CDT

Lunch
Friday June 22, 2018 12:00pm - 1:00pm CDT
TBA

1:00pm CDT

Sacrifice Decisions (Resilience Engineering Event Analysis)
(Note: This workshop complements the HRO staff ride workshop; both offer a different way of looking at and learning from events. ) 
 
This workshop was developed by Dave Wood’s Cognitive System’s Engineering lab at Ohio State.   We will demonstrate how to look at an event from a Resilience Engineering/complex system perspective, using a simulation inspired by a 2013 NASA incident in which an astronaut almost drowned during a spacewalk. Participants will assume multiple roles in carrying out and directing the spacewalk amid goals and constraints exploring how people make sacrifice decisions under messy conditions.  We will discuss how organizations can improve sense-making and decision making. 
 
Background: To fully understand system performance and how it degrades before and during an accident, it is crucial to be able to rationalize the small-scale behaviors of the practitioners closest to the accident in time and space (i.e., the sharp end). This is only possible by understanding how these behaviors are shaped by the pressures and constraints resulting from larger-scale decisions and actions of the blunt end. Chief among these is increased production pressure. Whether it is due to exploiting new technologies, creating more prescriptive policies and procedures, or leveraging past efficiencies to increase present and future throughput, this invisible force predictably contributes to changes in mindset, activation of buggy knowledge, changes in goal priorities, and changes in authority that can interact to degrade event detection, sensemaking, re-planning, and other macro-cognitive functions. But how can you see an invisible force?  We identify the most common ways that production pressure is expressed in the seemingly irrational adaptations of people throughout the system.  We will teach how these adaptations can be reconceptualized in terms of how sense-making and decision making occurred, which can then be traced back to the more global pressures and constraints. 
 
This workshop will be valuable for anyone interested in better managing complex system performance through applying the concepts of resilience engineering.     

Speakers
avatar for Asher Balkin

Asher Balkin

Research Engineer and Laboratory Manager at the Cognitive Systems Engineering Laboratory (C/S/E/L) at Ohio State University, Ohio State University
An interdisciplinary researcher who has worked in fields as diverse as public health, international security, surgical research, and human/automation interaction, Asher is known equally well for the quality of his research as for his sardonic wit. He is currently a Research Engineer... Read More →
avatar for Beth Lay

Beth Lay

Founder and Principal, Applied Resilience, LLC.
An experienced leader who helps develop resilient, reliable organizations. Four years experience as Director of Human Performance at Calpine Corp – an owner/operator of 80+ electric utility power plants. Seven years experience as the leader of Siemens Energy Field Service Risk Management... Read More →


Friday June 22, 2018 1:00pm - 5:00pm CDT
TBA

1:00pm CDT

HPI Error-Reduction Tools Interactive Workshop
Human Performance Improvement (HPI) enables us to work safer and more reliably.  
“To err is human...,” but does human fallibility doom us to failing over and over again? “Human error” is often attributed as the cause of events, whether we are talking about injuries, equipment damage, unit trips, environmental releases, etc. This leaves everyone wondering, “How can we reduce events caused by human fallibility?” For too long, there hasn’t been a good answer to that question.  
HPI is the application of principles and techniques specifically designed to reduce organizational events at all levels of the organization. This course will give you the information you a solid understanding of the HPI Error-Reduction Tools and examples of dynamic learning experiences to help people understand, practice, and retain those practices.   
Learning Outcomes: 
  • Discuss and Apply a set of human error reduction tools in an Electric Utility context. Including: 
  • Pre-Job Brief 
  • 3-Way Communication 
  • Phonetical Alphabet 
  • Self-Check/TV-STAR 
  • Post-Job Review 
  • Stop When Unsure and Questioning Attitude 
  • 2-Minute Rule 
  • Procedure Use & Adherence with Place-Keeping. 
  • Peer Check   

Speakers
avatar for Wes Havard

Wes Havard

OE Senior Consultant, Luminant
I was born at an early age, but I got older. After being accidentally left outside an all-you-can-eat barbecue joint outside Uncertain, Tx, I was adopted by a small family of Sasquatch. Eventually I made my way to the Martin Lake Power Plant where I was adopted by a family of OEs... Read More →


Friday June 22, 2018 1:00pm - 5:00pm CDT
TBA
 
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