Nuclear Safety Culture - Charles R. Jones

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10 Ships in the Nimitz Class CVN-68 Nimitz CVN-69
Dwight D. Eisenhower CVN-70 Carl Vinson CVN-71
Theodore Roosevelt CVN-72 Abraham Lincoln CVN-73
George Washington CVN-74 John C. Stennis CVN-75
Harry S. Truman CVN-76 Ronald Reagan (CVN-77
George H.W. Bush, 2009)
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Nuclear Safety CulturePanel DiscussionUS Navy
NSC PracticesModel NIMITZ Precommissioning
Unit1972 - 1975
American Nuclear Society June 2, 2003

• Charles R. Jones
• Nuclear Safety Consultant

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Navy Nuclear Propulsion Experience
ENTERPRISE CVN65 NIMITZ CVN68 BAINBRIDGE
CGN25 Nuclear Power Mobile Training Team 13
years 5 EOOWs (SROs) Chief Engineer
Qualification Chief Engineer Instructor
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DOE, NRC, Commercial Experience

• Department of Energy, Defense Programs 5 years
• Mix of Nuclear Safety Contracts for DOE, NRC, and
  Commercial Nuclear Power Plants17 years

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NIMITZ PRECOMMUNITNewport News
Shipbuilding1972-1975

• Special Problem Only 2 reactors (wanted 4)
• Concern for overall reliability and safety
• Crew selection viewed as key to success
• Result (hindsight) Optimal NSC

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Navy NSC Basics

• Goal Optimal reactor systems control
• Achieved using best proactive methods
• No-fault policy for most situations

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NIMITZ PRECOMMUNITNewport News Shipbuilding

• Crew Selection
• First Year Crew training
• Second Year Construction support/testing
• Third Year Critical testing and acceptance

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NIMITZ PRECOMMUNITNuclear Safety Culture

• Officer (Manager) roles
• Enlisted Personnel (Worker) roles
• NSC-Related Policies
• NSC-Related Practices

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NIMITZ PRECOMMUNITNuclear Safety Culture

• Officer (Manager) roles
• Take charge/responsibility
• Support enlisted personnel (workers)
• Conduct training
• No problem filtering (key point)
• Continuous self-training/retraining

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NIMITZ PRECOMMUNITNuclear Safety Culture

• Enlisted Personnel (Worker) roles
• Achieve technical expertise
• Identify/report all technical problems
• Push for problem resolution
• Understand/control operations
• Procedure verbatim compliance
• Continuous self-training/retraining

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NIMITZ PRECOMMUNITNuclear Safety Culture

• NSC-Related Policies
• No-Fault Problem Management
• No Problem Filtering

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NIMITZ PRECOMMUNITNuclear Safety Culture

• NSC-Related Policies (2)
• Upside-Down Organization
• Managers support workers
• Workers are the most important personnel

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NIMITZ PRECOMMUNITNuclear Safety Culture

• NSC-Related Practices
• Daily self training
• Weekly formal training
• Monthly progress reports to CO from each
  manager and worker
• Stop testing and fix it

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NIMITZ PRECOMMUNITNuclear Safety Culture

• NSC-Related Practices
• Monthly progress reports from each manager and
  worker
• All reports go to CO (CEO)
• Each manager adds a summary report
• Each report includes work completed, problems,
  obstacles, support needed, plans for next month
• No filtering/no fault

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NIMITZ PRECOMMUNITNuclear Safety Culture

• NSC-Related Practices
• Stop testing and fix it
• Procedures (Verbatim Compliance)
• No interpretations
• Focus on red flags
• Stop, correct (all), approve, proceed

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NIMITZ PRECOMMUNITNuclear Safety Culture

• NSC-Related Practices
• Stop testing and fix it
• Equipment
• Up-to-date technical manuals
• System Expert Factory visits
• Access for maintenance
• Proper tools for maintenance

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NIMITZ PRECOMMUNITNuclear Safety Culture

• RESULTS
• Ship commissioned on time
• All equipment fully functional
• No sea-trial problems with reactor or
  propulsion plants
• NIMITZ Class aircraft carriers a key national
  asset

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Three Key Points

1. Strong leadership
2. Workers first
3. Communicate all issues

Good Nuclear Safety Culture requires strong
leadership to establish policies and practices
that put the workers first and that communicate
all issues to the top manager. -Charles R. Jones
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Going ForwardNuclear Safety Culture

• Applications Today
• Definition of Nuclear Safety Culture
• Practical Implementation
• Davis-Besse Perspectives
• DOE Perspectives (Management)
• NRC Perspectives (Risk Informed)
• NSC Fundamentals Tutorial

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Good Nuclear Safety CultureMy Definition
Enabling framework
Positive inquisitiveness
The integrated body of specific characteristics
and personnel attitudes of an established nuclear
organizational environment consisting, in part,
of design, operations, maintenance, inspection,
and management policies and activities which
together ensure that problems are aggressively
sought out and that all concerns or issues raised
are promptly addressed in a way that maximizes
worker safety and public safety over the life of
the nuclear plant.
Safety over production
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Practical Implementation

• It is one thing to fix the general organizational
  and communication infrastructures. It is another
  to identify, implement, and sustain the needed
  upgrades to the supporting infrastructure.
• We also need to look at more nuclear-specific
  concepts and articulate managements policies and
  goals in those areas.

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Practical Implementation (2)

• From DB lessons-learned task force
• Acceptance of long standing hardware problems
• Weaknesses with the Employee Concerns Program
• Weak self-assessments
• Multiple examples of procedural noncompliance
• Lack of management involvement in safety
  significant work activities
• Lack of engineering rigor in their approach to
  problem resolution
• Strained engineering resources

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Practical Implementation (3)

• From DB lessons-learned task force - Other
  contributors
• Inspection guidance
• ASME code requirements
• Reactor coolant system leakage monitoring methods
  and requirements
• Inspection staffing issues
• Licensing processes
• Quality of documentation

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Practical Implementation (4)

• From DB Safety Culture Report
• Davis-Besse Key Safety Culture Issues
• Safety integration needed Industrial, Nuclear,
  Traffic
• Inadequate alignment of managers and non-managers
• Problem ownership weak

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Practical Implementation (5)

• From DB Safety Culture Report (continued)
• Realistic schedules are needed
• Minimal corrective actions due to production
  pressure
• Top down approach is overbearing
• Personnel low priority
• Organization chart not updated
• Training not a priority

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Practical Implementation (6)

• From DB Safety Culture Report
• Work coordination weak
• Reactive work vice planning to avoid issues
• Resource loading inadequate to solve problems
• Self assessments are sporadic and ineffective
• Professional development not provided

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NSC Fundamentals

• When do we apply verbatim compliance at this
  nuclear plant?  (When do we not?)
• What do we mean by "configuration management" at
  this nuclear plant and how do we implement it? 
  (Do we have control?)

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NSC Fundamentals (2)

• What do we mean by "life cycle maintenance" at
  this plant and how do we implement it?  (Are we
  thinking long-term?)
• What is our nuclear safety margin at this
  plant?  (What are we protecting?  Does it
  change?)
• What plant barriers provide protection to
  reliably prevent fission products from reaching
  the environment?  (Do we include protecting the
  spent fuel?)

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NSC Fundamentals (3)

• What plant design features improve reliability
  and compensate for equipment failures?  (Are they
  repaired/maintained at a higher priority?)
• What makes instrumentation at this plant
  accurate?  (Calibration and actual system
  testing?)
• Can the fail-safe performance of equipment at
  this plant be improved?  (Is it checked and
  protected?)

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Other Basic Concepts

• What will be management's disciplinary response
  to an incident in which a worker made a mistake
  that caused this plant to shutdown?  (Management
  responsible too?)
• When we at this plant encounter a procedural
  requirement that cannot be met as written, what
  course of action will we take?  (Reevaluate the
  entire procedure rather than just the one item?
  Skill-of-the-craft issues?)

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Other Basic Concepts (2)

• Risk informed methods provide a useful
  prioritization tool but are not standalone,
  definitive solutions.
• Risk informed is too often skewed to imply that
  something does not have to be controlled or fixed
  at all.
• Technical understanding and control are most
  useful in proactive environments.

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Concluding Perspective

• A good Nuclear Safety Culture
• Important to the success of the nuclear
  industry.
• Requires communications up and down the entire
  organization.