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System safety

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Through Strategy, Hazard and Safety

System approach

A system is defined as a set or group of interacting, interrelated or interdependent elements or parts, that are organized and integrated to form a collective unity or a unified whole, to achieve a common objective. This definition lays emphasis on the interactions between the parts of a system and the external environment to perform a specific task or function in the context of an operational environment. This focus on interactions is to take a view on the expected or unexpected demands (inputs) that will be placed on the system and see whether necessary and sufficient resources are available to process the demands. These might take form of stresses. These stresses can be either expected, as part of normal operations, or unexpected, as part of unforeseen acts or conditions that produce beyond-normal (i.e., abnormal) stresses. This definition of a system, therefore, includes not only the product or the process but also the influences that the surrounding environment (including human interactions) may have on the product’s or process’s safety performance. Conversely, system safety also takes into account the effects of the system on its surrounding environment. Thus, a correct definition and management of interfaces becomes very important. Broader definitions of a system are the hardware, software, human systems integration, procedures and training. Therefore, system safety as part of the systems engineering process should systematically address all of these domains and areas in engineering and operations in a concerted fashion to prevent, eliminate and control hazards.

A “system", therefore, has implicit as well as explicit definition of boundaries to which the systematic process of hazard identification, hazard analysis and control is applied. The system can range in complexity from a crewed spacecraft to an autonomous machine tool. The system safety concept helps the system designer(s) to model, analyse, gain awareness about, understand and eliminate the hazards, and apply controls to achieve an acceptable level of safety. Ineffective decision making in safety matters is regarded as the first step in the sequence of hazardous flow of events in the "Swiss cheese" model of accident causation. Communications regarding system risk have an important role to play in correcting risk perceptions by creating, analysing and understanding information model to show what factors create and control the hazardous process. For almost any system, product, or service, the most effective means of limiting product liability and accident risks is to implement an organized system safety function, beginning in the conceptual design phase and continuing through to its development, fabrication, testing, production, use and ultimate disposal. The aim of the system safety concept is to gain assurance that a system and associated functionality behaves safely and is safe to operate. This assurance is necessary. Technological advances in the past have produced positive as well as negative effects.

Root cause analysis

A root cause analysis identifies the set of multiple causes that together might create a potential accident. Root cause techniques have been successfully borrowed from other disciplines and adapted to meet the needs of the system safety concept, most notably the tree structure from fault tree analysis, which was originally an engineering technique. The root cause analysis techniques can be categorised into two groups: a) tree techniques, and b) check list methods. There are several root causal analysis techniques, e.g. Management Oversight and Risk Tree (MORT) analysis. Others are Event and Causal Factor Analysis (ECFA), Multilinear Events Sequencing, Sequentially Timed Events Plotting Procedure, and Savannah River Plant Root Cause Analysis System.

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