1 SYRAS & QMAS Applications Examples Bob Bea National Science Foundation RESIN PROJECT 2 P[F] = P[F I |E] P[E]+P[F I |E]P[E]+P[F E |E]P[E] due to intrinsic causes with no error due to intrinsic causes with error due to extrinsic causes with error 3 SYRAS 4 5 6 Example QRA/PRA 7 8 Proactive - Robustness = damage tolerance Intensity of damage or defects defect tolerant defect in tolerant 9 10 QA/QC Independent & Dependent Errors lack of expertise resource deficiencies excessive authority gradients communication malfunctions management breakdowns rejection of information violations Correction Detection Analysis 11 Probability of uncorrected extrinsic cause P(E): Quality Assurance and Quality Control (QA/QC) D = Detection A = Analysis C = Correction Base rate of Extrinsic malfunction 12 13 Probability of Error: P(E) new or rarely performed task extreme stress, very little time severe distractions & impairments highly complex task considerable stress, little time moderate distractions & impairments complex or unfamiliar task moderate stress, moderate time little distractions & impairments difficult but familiar task little stress, sufficient time very little distractions or impairments simple, frequently, skilled task no stress, no time limits no distractions or impairments Mean Probability of Human Error per Activity 14 15 16 Performance Shaping Factors (PSF) Interfaces Operators Procedures HardwareStructure Organizations Environments 17 18 SMAS/QMAS Assessment instrument Assessment protocol Assessment team development Follow-up 19 QMAS components 20 QMAS components, factors, attributes 21 QMAS factors 22 QMAS gradings 23 24 QMAS mean results Highest mitigation priorities 25 QMAS assessors QMAS counselor QMAS assessors Facility operators Facility management QMAS training program HOF background QMAS operations QMAS applications 26 QMAS assessors: THE MOST IMPORTANT PART! Experienced Facility Process auditing Respected Integrity Motivated Observant Thoughtful, insightful 27 QMAS applications 28 Sleipner A Platform Failure (U.S. $1 billion) Initiating Error in FEA Contributing Loss of corporate memory Cut-back in QA/QC Compounding Ineffective QA/QC design Ineffective QA/QC construction sank during construction 29 Sleipner FEA caused failure 30 All design phase accidents PSFs 2.0 E4 to 7.9 E5 COVs 1.4 to 2.1 31 32 33 34 35 36 I-QMAS design assessment Innovative system Innovative design Value Improvement Program (VIP) Cost - $ billions Time - months 0 12 37 I-QMAS assessment team Engineers from design contractors (DC) Engineering managers from DC Engineers from owner / operator (O/O) Engineering managers from O/O Outside engineers and managers HOF training program 38 Initial review Complicated procedures Low level engineering experience Debates with management Advanced technology Lack of evaluation of results of VIP on reliability 39 Q/SMAS components, factors, attributes 40 I-QMAS review results 41 I-QMAS recommendations Methods to evaluate reliability effects of VIP alternatives (SYRAS + QMAS) Implement challenge process for design procedures Assign experienced design engineers Temporarily assign construction & operations personnel Develop robustness design program