Agenda Item 5.2 MARITIME AND PORT AUTHORITY OF SINGAPOREAgenda Item 5.2 Maritime and Port Authority of Singapore Asia-Pacific Maritime Safety Agencies Forum Third Session BRIDGE RESOURCE MANAGEMENT Abstract Investigation of accidents and incidents relating to cockpit operations in the airline industry and bridge operations in the maritime industry have found that 80% of the accidents and incidents were caused by human error. Except for a few of the more reputable and larger shipping companies, the maritime industry, has generally been slow to adopt human facors training 38 part of the company’s safety programme. However, there are signs that this may be changing. Code B, Section VIII/2: “Guidance in Keeping a Navigational Watch” of the revised STCW Convention recommends that bridge resource management training be provided for watchkeepers. The Code lays down the principles and also list out a number of specific actions that should be taken. It emphasises on the need for continuous reassessment of how bridge- watch resources are allocated. The Bridge Resource Management (BRM) training programme is intended to address this issue. BRM training focuses on the human clement and not on technical skills. It is about changing behaviour and attitudes : = tomaximise operational effectiveness; = toimprove efficiency; = toprevent accidents and incidents; and = to preserve personnel and material resources Itis emphasised that BRM training must be educational and not evaluational. Studies have shown that a Cockpit Resource Management (CRM) course developed by one airline was not readily accepted by other airlines as certain concepts were found to be incongruent with their national and company culture. It was therefore necessary for the airline to develop its own CRM training which it felt would better promote the company’s culture. In Singapore, some shipping companies have started customizing their own BRM training Programmes, I is good if ll shipping companies could do it. However, there will be some companies who will not be able to develop their own in-house BRM training. The Singapore Polytechnic, Department of Maritime Technology and Transportation intends to provide BRM training to shipping companies. In addition, it will introduce BRM training in both the atchkeeping and management levels Certificate of Competency courses thatthe departments offers. ‘This paper will focus on the need for BRM training. Tt will cover the key issues such as what is required to produce the desired changes in attitudes and behaviour, its implementation and the need for recurrent training to reinforce and retain the desirable attitudes and behaviour.Agenda Item 5.2 MARITIME AND PORT AUTHORITY OF SINGAPOREBRIDGE RESOURCE MANAGEMENT Prepared for the Maritime and Port Authority of Singapore for the Third Session of the A: Pacific Maritime Safety Agencies Forum By Singapore Polytechnic Department of maritime Technology and Transportation INTRODUCTIO! 1 Many maritime authorities are discussing bridge Resource Management (BRM) as a means to effectively reduce accidents and incidents caused by human error, in particular those that may arise from navigational error. The airline industry has been using Cockpit Resource Management (CRM) training for many years. Its effectiveness as a tool to reduce accidents and incidents caused by human error has ‘been accepted. The experience of the airline industry in conducting such training can be a useful guide for the maritime industry as there are si cockpit of an aircraft and that of a ship's navigation bridge. 2 Like in the airline industry, investigations of accidents and incidents relating to bridge operations in the maritime industry have found that about 80% of the accidents and incidents were caused by human error. The maritime industry has now broadened its focus and understood that focussing upon technical competence alone is insufficient to reduce accidents and incidents at sea. This new attitude is visible in the larger companies operating in Singapore and the Asia region whereby it is quite common to find in-house BRM training being conducted for their ship's officers. However, the smaller companies are unlikely to take similar action unless BRM training is made compulsory through legislation, ‘SP/MIT/BRM/ VANE T‘Causes of Accidents and Incidents : A Case Study 3 Inthe maritime industry, it has been accepted that bridge management errors are the main cause of accidents 4 Cited below is a case study on the collision between a laden tanker and a passenger ship. At the time of the accident both ships were manned by competent officers and the visibility was good. It highlights that the ship’s bridge must not only be adequately manned but the bridge team should also be interdependent so as to cope ‘with the heightened situation, (@) The sequence of events of the accident are summarised as follows () The laden tanker was transiting a busy traffic separation scheme (TSS) eastbound during the night. The ship had advised the relevant authorities and the required navigational waming was broadcast through Navtex. During the passage through the deep-water route, the bridge was manned by the Master, Senior Chief Officer, Deck Cadet and the AB who was steering. Speed was reduced as required Gi) The passenger vessel, with state of the art navigation equipment (highly automated bridge) in a cockpit type setting, had departed the berth ‘under pilotage. The bridge team consisted of the Master, Chief Officer, Officer On Watch (OOW), 3" Officer, Pilot and the AB. The pilot disembarked at the designated area. The 3° Officer left the bridge to escort the pilot down. At the same time the Chief Officer left the bridge. The Master handed over the wateh soon after to the OOW. The bridge team now consisted of the OOW who was assisted by the 3" Officer and the AB. Gii) Prior to collision, the vessel traffic monitoring authority had advised the tanker that she has drifted into the Westbound TSS lane and she should keep a sharp lookout for a departing passenger ship. The tanker continued to drift into the Westbound lane while overtaking a small tug and tow. The tanker had informed the traffic monitoring authority of the tug and tow using the ‘SP7MITTBRMI VANS aab) ‘SP7MIT/BRM 7 VANS deep-water route. The Master detected a radar target 2-3 points on the port bow and the ARPA predicated that it will pass clear. Shortly after, the passenger ship was sighted by the Master which he estimated to be about 0.5 to 1.0 mile away. The passenger ship then altered to port and collided. (iv) The vessel traffic monitoring authority had advised the passenger ship to keep a sharp lookout for a tanker heading eastbound in the wrong lane of auto heeling system for passenger comfort. The OOW commenced the turn to starboard using the fully integrated navigation system at the predetermined ‘waypoint to join the TSS. Shortly afterwards the OOW observed a big target on radar 2 miles away, ARPA indicated the target was stationary. He then sighted the target and saw the lights of a tug (red open) and a large structure with many red lights (on the portside). He assumed that it was a tug towing an oiltig. Soon afterwards the tug showed green open (on the port bow) and he: assumed the tug and tow had altered course to enter the port. The OOW altered course to port to put tug ahead. He altered more to port when he saw the target was getting closer before colliding. The OOW claimed that he was not informed of the message received from the vessel traffic monitoring authority. ‘The likely causes of the collision can be summarized as follows :- (@ __Inrespeet of the tanker, the likely causes are ‘= ‘© Preoccupation with overtaking the tug ; © Pailure to delegate tasks and assign responsibilities to sight the passenger ship ; ‘© Inadequate monitoring ; and Lack of teamwork on the bridge.Gi) Inrespect of the passenger vessel, the likely causes are :~ + The Glass Bridge Syndrome where the state of the art navigational equipment dominated the watchkeeper’s mindset + Preoccupation with predetermined waypoints ; «© Preoccupation with non-navigational activity ; Failure to utilize available data ; © Inadequate monitoring of the environment ; Failure to detect or challenge deviations from the plan ; and + Lack of teamwork on the bridge. WORK ENVIRONMENT 5 As-can be seen from the above case study, human factor is the gle most important contributor to the accident. ‘The BRM training is therefore designed to address the human element, in particular, the ship navigating team. 6 The navigating team work and live together often under stress in an increasingly automated bridge. While enduring boredom at times, a navigator is required to maintain continuous vigilance during a sea passage, which for the most part is uneventful. This is alternated with periods of semi-intense activity during landfall and coastal passages and a period of intense activity during pilotage, berthing and immediately after unberthing has taken place, In addition to exercising his responsibility, a ship officer has to maintain effective interpersonal relations at all times within and outside the bridge team. 7 In carrying out his duties, a navigator has to comply with an increasing number of regulations, procedures and rules. Often under heavy pressure and suffering from fatigue due to intense period of work when the ship arrives or departs, and during cargo operations, the navigator is expected to remain calm, clear in thinking and free of impulsive tendencies. He must also be able to react instinctively and correctly in an emergency. ‘SP7MIT/BRM/ VANS +PRES! AND FUTURE 8 Code B of STCW 95, section VIH/2; “Guidance in Keeping a Navigational Watch” recommends that BRM training be provided for watchkeepers. The Code lays down the principles and also lists out a number of specific actions that should be taken. It emphasizes the need for continuous reassessment of how bridge-watch resources should be allocated. The BRM training program is intended to address this issue. 9 Upon further evaluation of the Code, a distinct direction towards addressing emphasized. Whi this is important, the Code does not go far enough in emphasizing training in the hhuman elements, BRM training should be more about changing behavior and attitudes the procedural component of maritime accidents and incidents as well as improving procedural skills. The ‘human factors’ training must be educational and not evaluational. The procedural training on the other hand can be both educational and evaluational. 10 Following the airline industry approach, the airlines have ‘basc checks” where cockpit crew are put through procedural and emergency situational training and assessment using the simulator. The CRM training on the other hand addresses the “human factors’ without the use of simulators. 11 Itis now evident that the maritime industry has two areas that it must address. ‘The BRM training should consist of two levels. The first level should cover enhancement on procedural skill, situation awareness, error chain detection and teamwork, preferably with the aid of simulators. This should be done at the watchkeeping level. 12 The second level BRM should cover effective leadership, resource management, error management, master / pilot relationship, procedural skill reinforcement and teamwork. The use of simulator is not essential at this level. ‘SP7MITT BRM VANE13 The BRM at the watchkeeping (operation) level is expected to run over three days (6 sessions). The first and second sessions will cover the different behavioral styles and teamwork. The simulator will be used on the third and fourth session to enhance procedural skills. In the fifth session the simulator will be used to emphasize the need to detect and challenge deviations from SOP / passage plan. The last session will stress on the importance of teamwork and interdependence for a safe and economical voyage. 14 The BRM at the management level is also expected to run for three days (6 sessions), The first and second sessions cover the traits of effective leadership and time management. The third and fourth sessions will reinforce the importance of procedural skills and teambuilding. The fifth and closing session will address the importance of behavioral styles and interdependence for the execution of a safe and economical voyage. 15 Asin any form of training, constant reinforcement is required and thus BRM at the management level should be repeated at intervals. The Singapore Polytechnic’s Department of Maritime ‘Technology and Transportation intends to introduce BRM ‘taining at both watchkeeping (operation) and management levels for Certificate of Competency courses that the Department offers. DEVELOPMENT OF THE BRM 16 Studies have shown that a CRM course developed by one airline was not readily accepted by other airlines as certain concepts were found to be incongruent with their national and company culture, It was therefore necessary for the airline to develop its own CRM training which it felt would better promote the company’s culture, 17 This view is shared by the local maritime industry at large. Asian cultures generally stress the absolute authority of its leaders. Junior officers from these cultures tend not to question decisions made by seniors as it may be construed as a sign of disrespect, Seniors from these cultures also do not easily accept the concept of interdependence. ‘SP/ MTT BRM 7 VANSB e18 In Singapore, some of the larger shipping companies have customized BRM training programs from the USA and Western Europe to meet thei own needs, It will be good if all the shipping companies could develop their own BRM training Programs. However most of the smaller companies will not be able to do so. The Singapore Polytechnic’s Department of Maritime Technology and Transportation intends to provide customized BRM training programs to these shipping ‘companies. There may be a need by some of the shipping companies who may take this opportunity to incorporate some simulator-based exercises into their BRM training Programs to enhance professional skills. One has to be wary that if the navigation team perceives the training to be evaluational in nature and not educational then the attempt to influence a change in their behavior styles may be lost, CONCLUSK 19 The BRM taining course objectives should be to influence changes in behavioural style and to lay emphasis on interdependence within the bridge team. In order to speed up the acceptance of BRM training culture in shipping, greater ning. This, we believe, will enhance safety and emphasis should be given to BRM tr reduce accidents and incidents in the maritime industry, which are attributed to human error. ‘etiben-orum-canada SP7MTT/BRM/VANOS Soa EE ed EEE