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    Bow Tie

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    userscribd2011
    This document discusses risk management and major accident events. It begins by outlining why risk management is important for business goals, regulatory compliance, safety, and reputation. It then describes the typical risk management process of planning assessments, assessing risks, and assuring actions are implemented. While risk management is useful, major accidents still occur when multiple barriers fail from issues like complacency or common mode failures. The document advocates for effective implementation of management systems with risk assessments, barriers, and assurance processes like audits. It argues that risk management is most effective when a proper system is in place and assessments drive implementation and assurance.

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    Bow Tie

    Uploaded by

    userscribd2011
    168 views27 pages
    This document discusses risk management and major accident events. It begins by outlining why risk management is important for business goals, regulatory compliance, safety, and reputation. It then describes the typical risk management process of planning assessments, assessing risks, and assuring actions are implemented. While risk management is useful, major accidents still occur when multiple barriers fail from issues like complacency or common mode failures. The document advocates for effective implementation of management systems with risk assessments, barriers, and assurance processes like audits. It argues that risk management is most effective when a proper system is in place and assessments drive implementation and assurance.

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    Bow-tie

    Original Title

    Bow-tie

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    This document discusses risk management and major accident events. It begins by outlining why risk management is important for business goals, regulatory compliance, safety, and reputation. It then describes the typical risk management process of planning assessments, assessing risks, and assuring actions are implemented. While risk management is useful, major accidents still occur when multiple barriers fail from issues like complacency or common mode failures. The document advocates for effective implementation of management systems with risk assessments, barriers, and assurance processes like audits. It argues that risk management is most effective when a proper system is in place and assessments drive implementation and assurance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    168 views27 pages

    Bow Tie

    Uploaded by

    userscribd2011
    This document discusses risk management and major accident events. It begins by outlining why risk management is important for business goals, regulatory compliance, safety, and reputation. It then describes the typical risk management process of planning assessments, assessing risks, and assuring actions are implemented. While risk management is useful, major accidents still occur when multiple barriers fail from issues like complacency or common mode failures. The document advocates for effective implementation of management systems with risk assessments, barriers, and assurance processes like audits. It argues that risk management is most effective when a proper system is in place and assessments drive implementation and assurance.

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    of 27

    Risk Management:

    Panacea or Snake Oil


    If Risk Mgt is so effective why do
    Major Accident Events still happen?
    AGENDA
    Risk Mgt Introduction
    Why Manage Risk
    What is Risk
    How is Risk Managed
    Major Accident Events
    Bow Tie Application
    Conclusions
    Risk Mgt
    Introduction
    Why Manage Risk
    Greater chance of Business Targets being met
    More effective management of strategy, tactics and
    investment
    Regulatory Compliance
    Corporate Governance
    Improve Operability / Reliability / Availability
    Improve Occupational Safety
    Prevention of Major Accidents which impact
    People
    Environment
    Relationship with Regulators (License to Operate / Fines)
    Reputation external & internal stakeholders
    Shareholder Involvement
    Access to Funds / Investment
    Risk Management Process
    Assure
    Plan
    Assess
    Risk
    Management
    Process
    Plan: Development (and implementation) of a project specific or annual Risk Management plan to
    identify what assessments are required, when they should be undertaken and who is responsible.
    Assess: Assess risks, determine if they are acceptable by comparing against tolerability criteria then
    if they are not, take action to reduce the risk to acceptable levels
    Assure: Monitor, review, audit and document the process to provide assurance that the actions have
    been implemented.
    Assess Risk
    Effective Risk Mgt takes place in
    the context of Effective
    IMPLEMENTATION of Mgt
    Systems
    RISK MGT NOT JUST ABOUT
    DOING SUMS
    Typical Mgt System Elements
    MULTIPLE BARRIERS
    Leadership / Commitment / Organisation
    Communication
    Risk Management
    Mgt of Change
    Regulatory compliance
    Competency
    Contractor Mgt
    Design, Ops & Maintenance controls
    Emergency preparedness
    Incident reporting & Investigation
    Documentation control
    Review & Monitoring
    Audit
    Focus on Major Accident Events
    Everybody does risk mgt
    Private Life (e.g. Driving / Cycling)
    Commercial (e.g. investment decisions)
    Occupational Safety (e.g. Hazard Spotting)
    Focus on one aspect - Mgt of Major Accident Events
    arising from Major Accident Hazards (MAH)
    MAH is defined as a hazard with the potential to result
    in:
    Multiple fatalities
    Major Environmental damage
    Substantial Loss of Asset / Plant Downtime
    Major Reputational Impact
    Some Major Accidents in Recent Years
    2005: Texas
    City
    1990: Mexico
    City LPG
    Disaster
    1987: Herald of
    Free Enterprise
    1984:
    Bhopal
    1996: Rincon
    de los Sauces
    Oil Spill
    2001: P-36
    1976:
    Seveso
    Dioxin Spill
    1988:
    Piper
    Alpha
    2000:
    Guanabara
    Bay Spill
    1977:
    A. Kielland
    2010:
    Macondo
    2009:
    Montarra
    MAE Characteristics
    Simple Initiating Event
    Multiple Barrier Failure
    Non Robust Barriers
    Common Mode failure a single failure takes out
    multiple barriers
    THERE BUT FOR FORTUNE
    Complacency - Occupational Safety performance
    is NOT ALWAYS an effective predictor of MAE
    Multiple Barrier Failure
    (Extract from BP Deepwater Horizon Accident Investigation Report)
    Two Populations?
    Occupational
    Major
    Accident
    Near Miss
    Incident
    Incident
    Near Miss
    Bow Tie
    Application
    Assure
    Plan
    Assess
    Effective Risk Mgt Plan
    Develop and Implement a risk based HSE Mgt
    System
    Carry out Focussed Risk Assessments at key
    stages of the business life cycle, Understand
    their output and Implement recommendations
    Use Risk Assessment to drive an Assurance
    Process to deliver effective operation
    Develop pragmatic leading indicators of MAH
    performance
    Application of Bow Ties
    Various Risk Mgt applications
    Concentrate of their value in:
    Facilitating the Planning and
    Understanding of Risk Assessments
    Driving Assurance processes
    Supporting Delivery of leading MAH
    indicators
    Use of Bow Ties
    A Bow Tie diagram is a pictorial representation
    of both the actions (or lack of them) that can
    result in a MAH and the multiple barriers (hard &
    soft) in place to minimise the risk. It depicts
    various measures, systems and / or factors
    which:
    Prevent occurrence of a MAH
    Control / minimize the hazard
    Lead to escalation of the hazard
    Minimize the consequential impacts of a hazard.
    Typical Bow Tie Diagram
    Linkage to the Mgt System
    Example Well Control / Overview
    Example Well Control / Causes 1
    Example Well Control / Causes 2
    Example Well Control / Consequences 1
    Conclusions
    Conclusions Risk Mgt
    STRENGTH
    Effective Tool to identify and
    mitigate risks throughout a
    company / project life cycle
    Cost effective when done at
    the appropriate stage of the
    Life cycle
    Powerful tool to drive risk
    awareness and an
    understanding of risk barriers
    into the workforce
    Demonstration (to Regulator
    / Stakeholders) of commitment
    to risk management
    WEAKNESS
    Complexity.
    The modelling of multiple
    barriers can be time
    consuming and results
    difficult to interpret
    Heavily information
    dependant. GIGO
    Scarcity of skilled resources
    Lagging indicators
    ineffective. Very infrequent /
    small population
    Dependant on HSEMS
    Implementation
    Conclusion Bow Ties
    Bow Ties can play an important part in this Risk
    Mgt process through:
    Improving Understanding: Communicating the
    results / meaning of RA into both mgt and
    workforce
    Providing Assurance:
    That RA recommendations are implemented
    That all barriers (hard & soft) are in place and
    effectively implemented
    Supporting the delivery of leading MAH
    indicators by driving assurance reviews / audits
    Overview
    Risk Management is Neither a Panacea Nor Snake Oil
    It can be a very effective tool but only provided that:
    A fit for purpose HSE MS is in place
    This HSE MS is implemented through effective
    management
    Risk Mgt is carried out by competent staff / contractors at
    relevant lifecycle stages
    Actions arising from risk assessments are properly
    implemented
    Management and Workforces perception of the Company
    Risk Management culture is aligned
    A rigorous Assurance programme is in place to verify
    /drive HSE MS implementation and the actioning of risk
    assessment recommendations

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