ACSF Safety Symposium Kicks Off with Compliance Focus

Procedural noncompliance remained front and center at the 2018 Air Charter Safety Foundation (ACSF) 2018 Safety Symposium, with experts pointing to pilot pressures as one of the chief factors playing into decisions that lead to violations.

ACSF held its 2018 Safety Symposium at the NTSB Training Center last month, covering a slate of safety topics ranging from decision-making to implementing an Aviation Safety Action Program, runway excursions, and managing communications after an aircraft accident. More than 120 senior industry, association, and government representatives registered for this year’s two-day ACSF symposium, which also featured a half-dozen exhibits.

Bob Baron, president of The Aviation Consulting Group, kicked off the event by pointing to pressure on pilots to complete missions, poor training, complacency, fatigue, and apathy as among myriad factors that play into procedural noncompliance.

These factors can have devastating consequences, he warned, highlighting the Nov.10, 2015 crash of a Hawker 700A that killed both pilots and all seven passengers The NTSB had pointed to a “casual attitude toward compliance with standards” in that flight, as well as an array of issues, such as a spotty employment history of both pilots involved.

However, he added the factors can be mitigated by a proactive and predictive approach that balances safety with operations.

Baron relayed personal pressures he faced while serving as a contract pilot, including operators chastising him for executing a go-around or deicing the aircraft, and being told to continue operating with a worn tire. He e noted that along with pressure from the company, pilots face pressure from interaction with passengers that could further lead to procedural noncompliance. Other pitfalls can come from a lack of training, high risk-takers, and even use of contract pilots that can make crew resource management more difficult, he said.

Addressing Noncompliance

Many of the compliance issues occur with good intentions, he said, giving as an example “if we get just a little lower, we’ll see the runway” and noting that many pilots view go-arounds as an emergency procedure.

But Baron stressed that balancing “production” with “protection,” where a strong safety culture is incorporated while still fostering strong operations, could help offset issues that might lead to noncompliance. He advised thoroughly vetting pilots, “looking for red flags,” and cautioned against “pencil whipping” or pressuring pilots to take an approach of checking boxes without full knowledge of what they just approved. He also advised implementing a strong cockpit resource management program.

A proactive approach—through safety management systems, safety reporting, and/or efforts such as FOQA—further will ward off noncompliance, he added. These efforts won’t prevent all accidents, he acknowledged, saying, “There is no silver bullet.” However, he added the efforts would provide the necessary ammunition to help provide appropriate safeguards.

Dave Huntzinger, director of aviation safety for Ornge, meanwhile, stressed that intentional non-compliance is a real issue. The May 31, 2014 Gulfstream GIV crash in Bedford, Massachusetts, put a spotlight on that with a demonstrated history of missed pre-flight checks, but a number of studies also have highlighted procedural intentional noncompliance, Huntzinger said. A Boeing a study looked at 232 commercial accidents and found two-thirds had some incidence of intentional non-compliance. On average there were four per accident with a case of 20 incidences.

Studies have further shown that “if you commit one you are much more likely to commit another one, “ he added, and said, “Basically all the studies come to the same conclusion: you get involved with intentional non-compliance you are setting yourself up.”

These events don’t always end in disaster, he said, “but many of them do end up that way because people tend to overestimate their abilities and underestimate the situation.”

He pointed to three factors set the stage for intentional non-compliance: a reward, a probability of success, and no adverse reaction from peers.

Rewards can come in many forms, he said, including financial incentives such as getting paid per flight. Or a reward can be a sense of duty to the operation and the feeling of a need to get the job done. The pilot further can be trying to please the client. Finally, he notes that the reward could be for other personal reasons, such as the pilot just wants to get home or wants to learn how to handle a new situation or just “go rogue.”

Huntzinger advised addressing the reward by eliminating the pay-per-leg scheme and go to a salary; implementing procedures that take the decision-making out of the hands of the pilot (ie. weather is bad so policy does not permit the air ambulance flight); or holding the line with a client, telling them “sit down and shut up or be banned for life.”