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ICAO / IATA LOSA TEM Conference LOSA OVERALL PROCESS Captain Chris Nutter Director Flight Safety Alaska Airlines.

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Presentation on theme: "ICAO / IATA LOSA TEM Conference LOSA OVERALL PROCESS Captain Chris Nutter Director Flight Safety Alaska Airlines."— Presentation transcript:

1 ICAO / IATA LOSA TEM Conference LOSA OVERALL PROCESS Captain Chris Nutter Director Flight Safety Alaska Airlines

2 Overall Strategic Process Union Partnership is Critical Union Partnership is Critical Project Definition Project Definition Objectives, Scope and Magnitude of the Effort Objectives, Scope and Magnitude of the Effort Resources Resources Administration & Logistics Administration & Logistics IT Issues, Hotel Rooms, Expense Reports, Deadheads, etc. IT Issues, Hotel Rooms, Expense Reports, Deadheads, etc. Organizational Management is Critical Organizational Management is Critical LOSA Plan Development LOSA Plan Development Execution Execution Daily Command Center for Operations Daily Command Center for Operations Post-LOSA Action Plan & Commitment (Do First) Post-LOSA Action Plan & Commitment (Do First) Improve the organization, operations and enhance safety Improve the organization, operations and enhance safety Feedback Feedback

3 Project Definition Project design requirements Project design requirements Business decisions Business decisions Number and type of observations Number and type of observations Research decisions Research decisions How long to accomplish How long to accomplish Logistics decisions Logistics decisions Post-LOSA process (and commitment) Post-LOSA process (and commitment) Management decisions (with Union Partnership) Management decisions (with Union Partnership) Suggest a 3-year plan Suggest a 3-year plan

4 Resources University of Texas LOSA Collaborative University of Texas LOSA Collaborative UT Preparation Checklist UT Preparation Checklist ICAO ICAO Document 9803 LOSA Document 9803 LOSA Industry Data Industry Data Company Data Company Data Published Literature Published Literature

5 Aviation Quality Database Third Party Audits (LOSA) Operating VPs Review all audit and performance data To develop corrective actions

6 Administration & Logistics

7 Alaska LOSA 2003 Program Research and Design LOSA Steering Committee Dec 2002 ALPA ALPA Magazine Dec 2002 ALPA ALPA Safety Sense VP Flight Ops / MEC Chairman Letter to Pilots Mailed Jan 29, 2003 Bid Packet Announcement Letter Jan 14, 2002 Flight Safety Newsletter Safe Approach Magazine JanJulDecJan Feb Mar Apr May SepNov Alaska Flight Safety OBS Training Data Validation Debrief LOSA Execution

8 LOSA Project Org Chart Cross Divisional Sanction & Support

9 LOSA Plan Development

10 Overall Plan Development Preparation – create a Steering Committee Preparation – create a Steering Committee Project Definition & Resources Project Definition & Resources Project Management Expertise Project Management Expertise Detail Planning Detail Planning Daily Execution Daily Execution Post-LOSA Data Validation Post-LOSA Data Validation Results Management Results Management Improvement Processes Improvement Processes Feedback Process Feedback Process

11 Scope of Observation Plan OBSERVERS OBSERVERS Observations Observations 2 Week Period 2 Week Period Provide Total Targets Provide Total Targets Each Self-Scheduled Each Self-Scheduled Allow Max Flexibility Allow Max Flexibility OBSERVATIONS OBSERVATIONS UT Baseline UT Baseline 3 Focus Areas Max 3 Focus Areas Max +5% Each Contingencies Contingencies +5% Sick Observers Canceled Flights UT + 20% Max UT + 20% Max

12 Defining Observation Schedules

13 Observer Plan Total Observers = 38 Alaska Pilot Core Observers29 Backup Staff Observers 7 University of Texas 2

14 Boeing Observation Plan Percent of Fleet # Observations & P ercentage & P ercentageB C9% 75 / 20% B % 200 / 54% B % B % MD8031% 100 / 27% Total Observations =

15 Research Process FOQA - Large quantity of data FOQA - Large quantity of data For 2002, total more than 26,000 flights For 2002, total more than 26,000 flights Data analysis Data analysis Mathematical Mathematical Statistics and Numerical Analysis Statistics and Numerical Analysis Trends and Regression Techniques Trends and Regression Techniques Basis for resource allocation for studying Basis for resource allocation for studying FOQA Events research FOQA Events research Aircraft-specific research Aircraft-specific research Airport-specific research Airport-specific research

16 FOQA Analysis Example 4 From Annual Report 2002 From Annual Report 2002 Selected 5 high threat indicators in D-A-L Selected 5 high threat indicators in D-A-L Examined these indicators Examined these indicators Independently Independently By aircraft type By aircraft type By airport frequency By airport frequency Cross examination of these variables Cross examination of these variables

17 © Alaska Airlines, Inc. - All rights reserved ILS-NPA-RNAV-RNP Approach Flight Operations 2000 feet to 1000 feet above touchdown [Event A] 1000 feet to 500 feet above touchdown [Event B] 500 feet above touchdown to touchdown [Event C] Flaps < Landing [Event D] Airspeed is VREF + X [Event E] Visual Stabilized Approach Point Symptomatic Factors Instrument Stabilized Approach Point

18 Event Rank (of all Events) Ranking E (Speed) D (Flaps) C (VSI) B (VSI) A (VSI) EVENT Targeted Observations for Highest Incidence Events

19 Targeted Airports AIRPORT 9 AIRPORT 8 AIRPORT 9 AIRPORT 4 AIRPORT 3 AIRPORT 2 AIRPORT 9 AIRPORT 2 AIRPORT 1 Top Airports Rank (of All Events) EDCBAEvent

20 Final Results Multi-Program Integration FOQA, ASAP, Reporting data FOQA, ASAP, Reporting data Identified Airports, ATC Arrivals of Interest Identified Airports, ATC Arrivals of Interest By Model Aircraft and Aircraft-specific Events By Model Aircraft and Aircraft-specific Events Operational Management Inputs Operational Management Inputs Fleet Captain, Training and Chief Pilot Fleet Captain, Training and Chief Pilot Union Inputs Union Inputs Targeted a system-wide assessment Targeted a system-wide assessment All nighters, Transcons, Arctic, Mexico, etc. All nighters, Transcons, Arctic, Mexico, etc. =Identify observer & aircraft assignments =Identify observer & aircraft assignments

21 Execution

22 Execution Prep Critical Success Factor - Communication Critical Success Factor - Communication Ensure the Organization knows the LOSA Project Officer (LPO) and their authority Ensure the Organization knows the LOSA Project Officer (LPO) and their authority Connectivity is crucial – cell, pager Connectivity is crucial – cell, pager Ensure LPO is available 24/7 or a rep Ensure LPO is available 24/7 or a rep Brief FAs, CSAs, Dispatch and SOC/DSO Brief FAs, CSAs, Dispatch and SOC/DSO TSA means jumpseat issues TSA means jumpseat issues

23 Execution University of Texas University of Texas Primary data and process manager Primary data and process manager Final Report Final Report ID LOSA Targets of Enhancement ID LOSA Targets of Enhancement Management Analysis of Report Data Management Analysis of Report Data ID Tops Issues, Events, Safety Concerns ID Tops Issues, Events, Safety Concerns Update the Post-LOSA Action Plan Update the Post-LOSA Action Plan

24 Post - LOSA

25 Post-LOSA Action Plan Broad Spectrum Data Acquisition & Analysis Broad Spectrum Data Acquisition & Analysis Flight Procedures Flight Procedures Company Policy Company Policy Training Programs Training Programs Qual Standards Qual Standards Content Content Delivery Delivery Administration of Manuals and Content Administration of Manuals and Content Answers Why do the FOQA events occur? Answers Why do the FOQA events occur? MPI Supports Training & 2006 LOSA Planning MPI Supports Training & 2006 LOSA Planning Communicating the data & results to others Communicating the data & results to others

26 THREAT / MGMT ERROR / MGMT CRM / MGMT THREATERROR CRM FACTORS PREVALENCEPREVALENCEPREVALENCE HIGH TO LOW N/A Colors = Crew Management Effectiveness Communicating the data to others

27 Checklists Stable Approach Definition Monitor Crosscheck Intermediate Threats & Errors Systemic Threat & Error Management Communicating the data to others

28 LOSA Results Management Line Pilot Focus Group Process Immediate 6 Months 12 Months 1 APR 04MAY 04JUN

29 LOSA Focus Group Action Plan Line Pilot Solutions to Line Problems 8 Focus Groups April-June with 24 Pilots on 9 Major Issues All Fleets – All Seats – All Bases 48 Man-Days of Work

30 * 80 Recommendations

31 Post-LOSA Action Process Focus Groups ALPA Line Focus Groups ALPA Line Recommendations Management Review Management Review STAN Process ALPA STAN Process ALPA ID Top Issues Implementation

32 What Does Alaska Airlines Do With the Data? Multi-Program Integration Is A Process For Continuous Improvement

33 V1 Cut Procedure Memory Item Reduction QRC / QRH Integration

34 Multi Program Integration - MPI INPUTS INPUTS AQP AQP FOQA FOQA LOSA LOSA REPORTING REPORTING ASAP ASAP O-53 O-53 SHR SHR CSR CSR CRM CRM OUTPUTS OUTPUTS 2005 CQ Recurrent 2005 CQ Recurrent Targeted Training Targeted Training Simulator events Simulator events Controlled Threats Controlled Threats Targeted Education Targeted Education Briefs / Debriefs Briefs / Debriefs Training Materials Training Materials Line Operations Line Operations Line Checks Line Checks

35 FEEDBACK Important To All Involved Groups – Pilots Management BOD

36 TEM GUIDE For 2005 Pilot Training

37 TEM Guide for Check Airmen It is NOT It is NOT NOT a grading tool NOT a grading tool NOT identified, logged or filed in any way NOT identified, logged or filed in any way It IS It IS Jepp sized LOSA Definitions, Targets for Enhancement, Alaska-specific results overview Jepp sized LOSA Definitions, Targets for Enhancement, Alaska-specific results overview Tool to facilitate familiarization with TEM Tool to facilitate familiarization with TEM Discussion generator to raise awareness Discussion generator to raise awareness Feedback for line pilots of our actual LOSA results Feedback for line pilots of our actual LOSA results TEM is 2005 CQ Theme and Line Check Focus TEM is 2005 CQ Theme and Line Check Focus

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