Performance Improvement in a Nuclear Laboratory Setting

1. Performance Improvement ina Nuclear Laboratory Setting Kathy Smith Director, PINO AECL, Chalk River Labs 2011 September

2. Agenda • What/who is AECL?? PINO? • The model • Corrective Action Program • Human Performance Program • Where are we going next? • Questions AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

3. Atomic Energy of Canada Limited • Established in 1952 to lead the Canadian nuclear industry. • Over 4,900 employees located across many sites. • CANDU recognized as one of the top 10 major engineering achievements of the past century in Canada. • Currently undergoing a significant restructuring with a re-focus to a Science and Technology organization (Canada’s National Nuclear Lab). AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

4. Key Chalk River Activities • Reactor Development • CRL Nuclear Operations • Research & Development • Isotope Production • Waste Management & Decommissioning AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

5. Performance Improvement and Nuclear Oversight (PINO) • Established as an organization in mid 2006 • Key to continuous improvement • Built on the framework of the Operating Experience Program • Provides insights to senior management on areas of performance vulnerabilities • Supports the operating license requirements • Reports to the Senior VP through the GM for Programs and Nuclear Oversight. AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

6. PINO Organization Dedicated team of auditors conduct performance based audits based on risk. Team provides oversight to the team of advocates and supports the use of Error Precursor Tools (Event Free Tools – EFTs) across the labs. • Staff responsible for: • Corrective Action Program • Trending • Benchmarking • Sharing of OPEX/OE • Change Management AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

7. Continuous Improvement Model Rules & procedures Number of Events Quality Control Quality Assurance Quality Management Human Factors ErrorPrevention - Human Performance 1960’s 1980’s 1990’s AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

8. AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

9. The Corrective Action Program AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

10. ImpAct “ImpAct” is the name chosen for the problem identification and corrective action program in NL and comes from the words Improvement and Action. ImpAct is a blameless program to capture information and take appropriate action to improve performance and prevent occurrence/ recurrence of significant events. AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

11. ImpAct Why ImpAct? • Correction Action Plan (CAP) program • Problems are identified and standardized • Individuals are assigned to correct problems • Trends are identified • Supports a strong reporting culture • Lessons learned are shared • Management oversight and engagement AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

12. ImpAct Process “Problems” include events, non-conformances, issues, and needs for improvement. They can also be identified in assessments, audits and program reviews. Problem Identification Initial Review & Approval (FLM) Management Review (MST and MRM) Remedial/ Compensatory Actions Verification & Effectiveness Review (MRM/IRB) Cause Analysis Corrective Actions AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

13. Improvement in Reporting Culture AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

14. Reporting Culture by SL of events AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

15. ImpAct Process Health Report AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

16. ImpAct Process Health Report Last 15 Months AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

17. The Human Performance Program AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

18. Human Performance: Guiding Principles • Organizational values influence individual behaviors • Performance is based on reinforcement and self-motivation • Recognition that people are fallible, and even the best make mistakes. • Error-likely situations are predictable and preventable, but only if we recognize them. • Events can be avoided by understanding past events (OPEX) and applying lessons learned. AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

19. Top 10 Error Traps… Stress High work load Time pressure Poor communications Vague/poor work guidance Overconfidence Infrequent or first time task Distractions First working day following time off > 4 days The end of a shift or work cycle All Feelthe Same Put us in orkeep us in Knowledge Based AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

20. Program Advocates: Development Strategy AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

21. Human Performance Advocates: Roles • Act as informal leaders within their organizations, they use the language and model the desired behaviours. • Support managers and supervisors in implementing Human Performance by providing a ready resource when those leaders are uncertain or have questions of interpretation (Advocates are the first link in the “help chain”). • Established points of contact within the line organizations, they act as a resource for the Human Performance program, by: • providing feedback to Human Performance branch about successes and challenges, • representing their lines to assist in development (ensuring Human Performance program initiatives align with the needs of the line) and provide review and comment when Human Performance program elements are being revised, and • acting as peer contacts for advocates in other lines, to allow sharing of ideas and experience. AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

22. Key Program Metric: Event Free Day Reset AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

23. EFDRs – Communication Format EFDR: Event Free Day Reset. Q4TD: 7 Q3 Target: 5 YTD: 25 Fy 10-11 Target: <20 Think Human Performance. AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

24. Event Free Tools vs. EFDRs in FY 10/11 – Q4 EFDR: Event Free Day Reset. Think Human Performance. AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

25. NL HU Performance - Days Between EFDRs EFDR: Event Free Day Reset. (7.2) (15.3) Think Human Performance. AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

26. Mini Safety Culture Surveys • AECL’s Nuclear Laboratories have committed to perform ongoing quarterly Safety Culture “mini-surveys”. Each of these will take a snapshot of our progress. The sample size will be approximately 20% of the Nuclear Laboratories staff for each survey, with the sample drawn from across the organization. • The first of these surveys was conducted between May 17th and June 2nd. • The second is scheduled to run October 4th -20th . • The survey is administered by an independent outside contractor and delivered electronically through a unique hyperlink provided by email to each employee in the sample. • The survey consists of 73 questions, and takes approximately 20-30 minutes to complete. The framework for the survey is based upon the eight principles described by WANO (World Association of Nuclear Operators), and is being used across the entire US commercial nuclear fleet. AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

27. Our next steps AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

28. Where do we go from here?? • Continue with roll out training on Human Performance Fundamentals • Enhance the tool that supports the Corrective Action Database • Strengthen the Field Observations program (Leaders in the Field, Paired Observations) • Develop and implement robust trending tools to support early identification of vulnerability • Implement a Benchmarking program that captures lessons learned and actions from interactions with our peers • Continue with mini Safety Culture Surveys AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL

29. Questions?? AECL - OFFICIAL USE ONLY / À USAGE EXCLUSIF - EACL