Institut pour la Maîtrise des RisquesSûreté de Fonctionnement - Management - Cindyniques
15 mars 2019 IMdR – 12 av. Raspail 94250 Gentilly – 0145364210 – [email protected]
Ago-antagonistic Systems: A case study of Risk Management by Safety Leadership and Preventive & Detective Management Controls on
Subcontractors in the French Alternative Energies & Atomic Energy Commission
(CEA)
Diana Paola MORENO ALARCON
Ph.D Directors: Franck GUARNIERI Aude DEVILLE
CEA HOF Experts: Jean-Francois VAUTIER Guillaume HERNANDEZ
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Plan
Purpose & Motivations of the Study
Overview of the Research
• Systems thinking (ST)
• Application of Systems thinking to Safety
• Ago-antagonistic Systems (AAS)
• Examples of Ago-antagonistic (AA) Couples in the industry
Implications of Ago-antagonistic Systems in Risk and Safety Management
• Research Question
• Method and Data collection
• Case study of AAS
• Intermediate Results & Discussion
Conclusion
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Purpose & Motivations of the Study
Aim of the thesis:
• Study the interactions between the actors (subcontractors, contractor & nuclear authorities) at a nuclear facility:
• Strategies that manager’s employ to manage the actions and decisions of subcontractors, to ensure:
• Procedures are performed in line with specifications [Relational risk]
• Results are obtained in accordance with commitments [Performance risk]
• Compliance with safety and security standards [Compliance & Regulatory Risk]
• Thereby, :
• Yielding a strong transmission of skills and experience between subcontractors
• preventing and mitigating subcontracting risks
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Overview of the ResearchFACILITIES
ACTORS
CONTROLS
MANAGEMENT
SAFETY
RISKS
DISTANCE
OTHERMANAGEMENT
STRATEGIES
FACILITY A FACILITY B FACILITY C
Subcontractor Contractor External Regulatory Body
Social control Behavior control Output control
Informal controls Formal controls
Preventive Control Detective control
Compliance & Regulatory Risks Relational Risks Performance Risks
Distance
Subcontractor Contractor
Safety Leadership Empowerment leadership Model+
Management Control Systems
Safety Performance
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Systems thinking
A system:
• “ global unit made up of a set of elements which interact together in a dynamic manner and are organized to achieve
a specific goal”
(De Rosnay, 1975, 2014)
System Thinking :
• connects the units of a system, provides a holistic vision , sheds clarity on the effect of their interactions
(De Rosnay, 1975, 2014)
• combination of organizational tools that analyze complex interactions between multiple actors, at multiple levels and the
interaction between these actors and the system.
→ global template: elements acted upon directly or indirectly by changing a parameter in parallel to the element.
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Applying Systems Thinking to SafetyHelps manage complex system of interactions at every level of the organization by :
• identifying interactions, considering the complexity, assessing effects on safety
(IAEA, 2014; 2016; Leveson, 2004)
“Events” = degradation of safety performance
→ Traditional causal analysis tools → linearly ( cannot analyze complex interactions – actors- temporal -spatial
gaps- consequences ) (Goh et al., 2010)
→ Systemic modeling tools (AAS) → act upon elements of the system & account for how actions (direct-
indirect, single- multiple) affect entire system.
“only complexity can cope with complexity” (Weick, 1979)
• only complexly-designed management systems can cope with risk complexity of safety environments.
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Ago-antagonistic Systems
E. Bernard-Weil formalized AAS:
• work on adrenal-post-pituitary interactions in Cancer patients.
• Vasopressin (Hormone X) and adrenal-cotico steroids (Hormone Y)
“Ago-Antagonistic” (AA) : (Bernard-Weil, 2002; 2003)
• antagonistic meaning “opposite effects”
• agonistic meaning “parallel positive effects”
→ opposite and commentary but inseparable to understanding the phenomenon
Systemic vision consider the collective impact of:
• adjusting either a single force (x or y) or both forces (x and y),
• particularly as action(s) on the couple may rebalance the overall system
(Bernard-Weil, 1999, 2003)Receiver
Regulator
Ago-antagonisticForces (x & y)
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Examples of Ago-antagonistic Couples
CEA
Network Hierarchy
Centralized Decentralized
Cooperation Competition/conflict
Management Control System
Reflection ActionShort Long Term
Individual Collective
Evaluate Control
Subjective Objective Avert Detect
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Implications of AAS in Risk & Safety ManagementResearch Questions
What strategies do CEA managers employ to prevent and mitigate subcontracting risks?
How can we apply systems thinking to these strategies to design new approaches to risk and safety management that take
into account the complexities of the system and overcome the limits of current Management Control Systems practices?
------- ------- -------
How do Ago-antagonistic strategies evolve over time (following an event)? Can these changes help mitigate the temporal
constraints of risk management?
How can these Ago-antagonistic strategies be applied in designing a formal mechanism (Balance Score-card) to help
managers determine the optimal balance of these Ago-antagonistic pairs?
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Abductive case study : "“constant movement back and forth between theory and empirical data” (Wodak, 2004: 200)
Numerous Field immersions → Facility A, B & E
• 8 data collection /analysis phases , 33 recorded semi-directive interviews (42h), 266h observations
Phase 5Phase 4Phase 3Phase 2
May 2-4 (3 j)
CP6Int1
CP7Int1
May 30- June 3 (5 j)
CP8Int1
June 27- July 8 (10 j )
CP 6Int2
CP 9Int1
CP10Int1
CP11Int1
July 25-29 (5 j)
CP12Int1
CP13Int1
CP14Int1
Site 1 from May 2 – July 31 2016
Phase 1
March 14-18 (4 j)
Interviews:
MP1Int1
MP1Int2
MP1Int3
MP1Int4
MP1Int5
MP2Int1
MP3Int1
MP4Int1
MP5Int1
Analysis of
Phase 1 Data
Site 0 in 2016
Phase 7
May 27 &
June 24-25 ( 3j)
MP15Int1
MP15Int2
MP16Int1
Site 2 in 2018
Phase 6
Analysis of
Phase 2 Data
Analysis of
Phase 3 Data
Analysis of
Phase 4 Data
Analysis of
Phase 5 Data
Analysis of
Phase 6 Data Analysis of
Phase 7 Data
Site 1 in 2018
v vv
March 5&22 (2 j)
CP7Int2
CP7Int3
Phase 8
August 20-31 (10j)
MP17Int1
MP18Int1
MP19Int1
MP20Int1
MP21Int1
MP22Int1
MP21Int2
MP22Int2
MP23Int1
Analysis of
Phase 8 Data
Method & Data Collection
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Case Study :
Management Control Systems
” combination of control mechanisms designed &
implemented by management to increase the probability
that organisational actors will behave in a certain way”.
(Abernethy & Chua, 1996)
→ Contain limits : observations & evaluation declared by
subcontractor.
Facette 1 Facette 2
Safety leadership
“process where leaders persuade followers [to achieve
organizational goals”.
(Simard & Marchand, 1995)
→ Leadership styles characteristics: flexibility,
development new ideas & initiatives
(Katsa & Condrey, 2005
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Case Study :
Management Control Systems
Cohesive actions : effective, measurable- shaping &
controlling human behavior
→ Lack concern : motivation, flexibility & personal
development (Morsing & Osward, 2009)
Facette 1 Facette 2
Safety leadership
Non-coercive actions: loyalty, safety culture & social
dynamics,
→ difficult to quantify/ measure: leadership performance
(Morsing & Osward, 2009).
*** opposite, antagonistic effects : complement one another → impact safety management practices
*** parallel positive, agonistic effects: augmented → impact safety performance.
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Case Study :
Facette 1 Facette 2
The AA model for MCS & safety leadership:
• Four components:
two forces (x, y), a regulator and a receiver
→ CEA (regulator)
→ management strategies (MCS, safety leadership)
→ safety performance (receiver)Receiver
Regulator
Ago-antagonisticForces (x & y)
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Case Study : Research Setting
B
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Intermediate Results & Discussion
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Facility A Facility B
MCS
Independent (infrequent)
MCSSL Safety Leadership
Initially: IndependentChanges to leadership practices : dependent (daily & simultaneous)
Daily co-activity meetings: staff across 4 system levels
Formalized H&S training : « safety minute »
- led middle management
- at the end of the co-activity meeting
Documentation Meetings: formalized meeting
Intermediate Results & Discussion
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Facility B
MCS Safety Leadership• Maintains tension between AA forces
• Balances opposite & complementary
poles by
→ combining MCS & Safety Leadership
simultaneously in management practices
Intermediate Results & Discussion
Detect inadequate
safety behaviors
→
Transforms inadequate
behaviour
Regulating safety procedures through employee
empowerment to improve safety performance
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MCS & Leadership Results5 Dimensions of the Empowerment Leadership Model (Arnold et al., 2000)
1. Leading by Example- leader demonstrates their commitment to safety
2. Coaching- encourages problem solving → members share & increase knowledge
3. Participative Decision Making – encourages expression of opinions & cohesive environment
4. Informing – members are informed of changes to procedures on a regular basis
5. Showing concern/ Interaction with employees- opens dialogue & positive rapport with members of the team
ELM: amalgamates task-focused behaviours ( informing) & person-focused behaviours (showing concern)
→ Task Focused: Facilitates understanding of task requirements, operating procedures & OP compliance
→ Person-focused : Facilitates behavioral interactions & influencing attitudes essential in teamwork
→ ELM: motivates subcontractors to surpass compliance of safety standards (via formal safety systems) to encourage new
safety initiative (via informal safety discussions) that encourage reporting near misses and minor events.
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MCS & Leadership ResultsCo- activity Management
• Daily meeting (vs. weekly)
• Inclusion of all staff from 4 systemic levels (vs. 2 in weekly)
Increased Interaction with employees (ELM 5) → subcontractors voice suggestions for daily operations
Participative Decision Making (ELM 3)→ discuss contingencies in case of unexpected Operational Changes
→ Encourages new safety suggestions & re-enforces environment to report near misses/ minor events
Health & Safety Training
• Formal Safety Minute at the end of co-activity meeting (4 systemic levels) (vs. occasional annual safety week)
Allows leaders to demonstrate their commitment to safety by Leading by Example (ELM 1)
Communication platform for safety concerns , safety reminders, identify areas that require Coaching (ELM2)
→ re-enforces organizational safety commitment & empowers subcontractors through education
Documentation
• Implementation of meetings between 1) Senior & Middle management & then 2) middle management & subordinates (vs.
notification of new documents via email)
Ensures the dissemination of crucial safety references (Informing- ELM 4)
→ Provides time-period to voice concerns with new guidelines
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”Principle of Sensitive Dependence on initial conditions”
“Metaphore of the Butterfly Effect” :
event as small as the flap of a butterfly’s wings can cause changes in weather patterns.
Conclusion
Systems consist of complex network of elements: can interact in an AA fashion.
Changes or actions to one AA couples→ impact other AA couples within the system.
→ interconnectivity of the elements in the system: minor actions can create major results
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Thank you for your time & your attention
Diana Paola MORENO ALARCON
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