CASA’s drive to change ‘just culture’

However, we have now reached a point where CASA has made it clear that it regards any information it obtains, regardless of the circumstances by which that information is provided, as a potential basis for administrative action. This is a problematic attitude.

Question marks over just culture?

In September 2010, at ICAO’s 37th General Assembly, the Australian delegation presented a workingRegionspaper entitled ‘Some Caveats on Just Culture’. The paper set out reservations on the concept of just culture and the protection of safety information.

It questioned the definition of just culture, suggesting that “the uncritical adoption of that expression for universal application is at best premature and fraught with risk. ” The paper also suggested safety information should be able to be used for administrative action and that the most suitable administrative action “may involve the variation, suspension or in some cases even the cancellation of a person’s civil aviation authorisation. ” With due respect to the drafters of that 2010 working paper, their assertion that principles of just culture are too broad is not accepted. The concept of just culture is recognised across the global aviation industry as fundamental to a safety reporting culture. A just culture is based on principles of confidentiality and voluntary reporting. Any attempts to undermine this will also affect the continuance of frank and open relationships with the regulator.

ICAO has devoted a section of the 2013 edition of its Safety Management Manual (Doc 9859) to the concept of ‘safety culture’. Paragraph 2. 6. 17 of the SMM states that “safety information should be collected solely for the improvement of aviation safety, and information protection is essential in ensuring the continued availability of information.

This may be realised through a safety reporting system that is confidential, voluntary and non-punitive. ” Indeed, for a safety information regime to operate effectively, the concept of just culture must exist, which encourages individuals to report quickly, frankly and fearlessly anything that could be related to safety, including their own mistakes and mishaps. People must be confident that disclosure of an honest mistake not involving deliberate or reckless conduct will not result in punishment – whether that be from an employer, regulator or prosecutor.

Valid industry concerns are therefore raised when CASA attempts to distinguish between “punitive” and “non-punitive” action, and then to seek to define administrative actions such as the suspension or cancellation of a person’s civil aviation authorisation as non-punitive. This only serves to undermine attempts to implement a robust protection of safety information regime and culture globally.

In many respects this is an issue of common sense. The suspension or cancellation of an authorisation or licence is clearly a punitive action. It is highly likely that an individual, faced with an action such as this, or with his or her employer being shut down, will think twice about reporting a safety incident. In such cases, there is a risk that errors and unsafeactions will remain hidden and organisations and regulators will lose opportunities for improvement and prevention.

Representations by other countries at ICAO

At last year’s ICAO General Assembly, representatives from a wide range of states came together to affirm the current ICAO approach to safety information protection and the principles of just culture.

It is informative to consider the papers submitted by a number of participating states and observer international organisations, each of which reiterated the importance of the just culture concept. Of particular interest to Australian operators was the contribution from South Korea, which argued the establishment of a reporting system in which “any individual may freely make a report without concern of punishment or disadvantage” is “vital to a voluntary incident reporting system. ” Additionally, South Korea noted that “the key to a successful voluntary incident reporting system lies in the voluntary informants’ confidence in the non-punitive consequences of their actions in providing information,” and that “in the case of states which manage the non-punitive principle through their administrative guidelines, a government authority should be made to make a written commitment that [they] shall not utilise voluntary incident reporting as material with which to seek punishment. ”

Conclusion

Fundamentally, safety information should only be used for safety purposes. In the eyes of the people disclosing safety information, action to suspend or cancel a licence is not seen as a safety purpose for which safety information should be used, and a pillar of any good reporting culture is confidence that when reporting people will not be penalised for honest or reasonable mistakes.

The long-term public benefits of the dissemination of safety information far outweigh any clearly identifiable benefits of the regulator engaging in administrative action for honest or reasonable mistakes.

In an important development, the government’s Aviation Safety Regulation Review provides an opportunity for a reality check of the issue of aviation safety in Australia. It is also a key opportunity for regional aviation to have its say, not only on the protection of safety information, but other areas of concern with the Australian aviation safety regulation regime. In this regard, the RAAA encourages its members to think about these issues and voice their concerns and their suggestions to the review, either through the RAAA or individually.