Human factors are central to many quality management systems. Clause 7.1.4 of both ISO 9001:2015 and AS 9100 require us to consider human and physical factors in the environment for the operation of processes, including social, psychological and physical. And as we emerge from the global lockdowns caused by the COVID-19 pandemic, we find that human factors may require even more focus and consideration than ever before, indeed they may play an even more crucial role in your organization’s journey to resilience than ever before.
Today organizations are navigating a new context. The landscape is much altered since the recent COVID-19 pandemic. Organizations are faced with a number of possible challenges. These include the loss of key clients, a downturn in orders or order volumes, delays to existing orders, cancellation of long-term programmes, concerns about mergers / acquisitions / take-overs (though these scenarios may indeed also provide strategies for organizations to help ensure their future viability), a sudden downturn in cashflow with continued fixed cost commitments, a change in investors perhaps (with government financial support being provided in some cases), supply chain disruption, especially those key providers that are critical to product realisation, and ongoing compliance with certification and contractual obligations, the loss of which may prevent shipping. There is much to consider.
Setting the new direction of travel
Organizations are reassessing their plans, realigning objectives and deploying new strategies and tactics on their journey to resilience. The role of senior management is to set the new direction of travel and guide its internal teams and external stakeholders, including suppliers, through a series of revised processes and adjusting the resourcing and scale of operations appropriately. Successful deployment of these new processes is vital if the sector is to survive and prosper. Consequently, organizations will need to pay close attention to its human factors; its people. It’s well acknowledged that people make an organization, and they have been through varying degrees of changes and challenges during the lockdown phases.
In some very sad cases, employees may have lost family or friends to Coronavirus and will still be dealing with bereavement.
A few may have enjoyed certain aspects of the lockdowns, spending quality time at home with immediate family for example, or more time for hobbies or pastimes that have long been ignored.
The loss of freedom to go out to the pub, out for dinner, to go to events or social gatherings, or indulging in some other passion that involves being away from home such as sport, may have been of little consequence to these individuals.
Others, however, will have found life in lockdown more of a challenge; feeling frustration at the restrictions, not able to indulge their sporting passion by watching the game or indeed playing, or simply suffering from cabin fever!
And for those with children at home, noise-cancelling headphones may well have been a good investment!
Coping with the economic impacts
As time goes on, the economic global impact of the COVID-19 pandemic are more and more evident. Whether furloughed / laid off or not, it’s likely people will be monitoring the impact on our world economies, and for those working in aviation and aerospace they are likely to be watching the unfolding effects very closely.
The aerospace industry has been hit harder than perhaps any other. A massive overnight reduction in global air travel, airlines going into administration, aircraft orders being cancelled, and the big primes cutting their headcount by 10 or 15% (indicating a similar if not greater knock-on down through the supply chain as every tier strives to survive, conserve cash and remain viable in order to survive the storm).
The phases of change
The different types of changes staff may have experienced during the pandemic can be illustrated using the Kübler-Ross change curve.
Change curve. Source: Kübler-Ross (1969).
The initial shock phase, which peaks at denial, gradually turns into a downward turn of energy as the shock and denial morph into anger. The line then descends to the bottom of the vertical axis as it hits depression. At this stage, the person is at his or her lowest ebb. As time goes on, the normal curve says that the energy levels begin to return as the person goes into experiment, such as going back to that long-forgotten hobby or starting something new like hitting a fitness regime. They may also decide to become a couch potato and enjoy watching all the box-sets on TV or read avidly.
During the furlough phase, there has been a noticeable increase in sales of house paint and DIY products as people get down to jobs long put off. I know, we did exactly that, buying paint for the dining room and kitchen; even though I was not furloughed, it was decided we needed to get on with some chores! So this morphs into an upward line again, ascending from experiment through decision and finally to acceptance of the new situation, so a new normal is established.
Be aware however that there is a risk that for a small few, when they get the low ebb in the depression phase, instead of beginning the ascent through experiment, decision and acceptance, they can get into a spiral in the depression phase. Governments around the world have reported an increasing concern about mental health during the lockdown, an increase in family issues and tensions, even violence in some sad cases.
Employees are likely to have concerns about returning to work and may be seeking reassurance from their employer that appropriate precautions have been taken to reduce the risks of viral transmission, including hand-washing, availability of antibacterial gel and social distancing. We are all much more conscious now of every point of physical contact, including touching door handles, touch screens, lift buttons, escalator rails (risk assessment – hold the rail for safety, or don’t touch for hygiene?). The world feels strange and behaviours learned over a lifetime now have to be changed. No shaking hands with friends or colleagues! It feels very odd.
So, as an employer, manager and leader, you will be faced with a workforce who are navigating lots of change to embedded patterns of behaviour. And having revised your context and strategy and formulated your plans, so you must now be mindful that your staff may be re-entering the Kübler-Ross change curve!
They will have been through the acceptance phase and are back up to their normal levels, so returning to work will require adjustments. Those on furlough may have got used to a late lie in, relaxed breakfast while watching morning TV (torture!) and having time to do as they please. Now they are faced with the alarm clock, early breakfast, and the commute to work! So again, they are going to go through shock, anger, denial, perhaps down to depression, but hopefully quickly back on the ascent to acceptance.
The next normal for facilities
For employers, back to work plans include a range of measures they are unlikely to have dealt with before. Work-stations now need to be 1 or 2 metres apart. Routes, such as walkways around the facility, may need to be one-way. Plastic curtains between work areas that people would previously brush aside, now present a possible hygiene risk. And where previously they would have told their staff to hold the handrail on the stairs for safety, suddenly they present a separate and contradictory risk. Everything with a button or handle has suddenly become a potential hygiene hazard. CNC programming panels, computer keyboards and product samples used by sales teams should also be considered. And of course, thought is required about how shared facilities, including canteens, water stations, tea and coffee facilities, and restrooms are safely managed. All these need to be thought about and planned for, with risk mitigation or elimination in mind. The work place is going to change.
The physical layout of sites may undergo significant change as part of risk mitigation plans. People that used to face each other may now have to sit back-to-back to avoid possible transmission. Screens may have been erected between people and between work areas. This will undoubtedly change how colleagues interact. So instead of communicating as they work, sharing information, engaging in the job at hand, enjoying some banter and repartee, they may be divided. An element of the pleasure or satisfaction that people derive from work is social; talking to friends and colleagues during the day, interacting, joking, just being human and socialising and exchanging pleasantries, telling yarns. These things may all be curtailed and could have an impact on staff wellbeing if they feel isolated in any way.
New work flows
Product flows may have been revised to take account of social distancing measures. Critical hand-offs between activities or processes may be adversely affected. Will information flow be compromised? New work flows may have a significant effect on how a product realisation stream works.
When an auditor is reviewing a process or workflow, or auditing shifts - particularly shift hand-overs - part of the assessment is focused on the effectiveness and completeness of communication, the effectiveness of handovers, the complete and full understanding of the status of a part or product, the stage in the process, and any issues that have arisen during the day that the night-shift needs to know about. All these elements can be adversely affected. Even more so if worker have been away from work for a period of time.
Each process flow or product realisation stream is a team or series of teams. The individuals that make up these teams may have been off work, going through the Kübler-Ross change curve with the varying effects as discussed earlier.
Recalibrating your winning teams
Think of a sports team that has achieved greatness. Football, cricket, rugby, whatever the sport, the team may be packed full of world-class talent, the best of the best, but if they don’t gel as a team, they are not effective. The most effective teams become as one; they anticipate the next pass, they know what their team-mate is planning to do so make sure they are in the right position for the cross. They engage, cooperate, anticipate, and as a result, they score goals, points, runs. They are winners. But they need to train together to maintain the peak. If there is a break, a pause in training, they have to work to get it back, to get back to that team with a single mind.
Let’s put that into a workplace context. With all the organizational changes, have your teams changed? Have you moved individuals out of teams and into others? Have you removed one or more of the team due to reductions in demand? Are there completely new teams?
There is a model for the stages of team development, just as there is the Kübler-Ross model for change. You will almost certainly be familiar with it; Tuckman’s model of team development, with four phases; forming, storming, norming and performing.
The Five Stages of Team Development. Source: Tuckman (1965).
The model starts with the ‘forming’ phase, so the team coming together. The line then drops down over time as the team ‘storms’. This is the low ebb. After that, over time, the line ascends through ‘norming’ and gets to its peak at the ‘performing’ phase. The team is the best it can be.
The curve is almost identical to the Kübler-Ross curve! So in effect, you have two sets of changes going on concurrently.
Getting match fit!
So back to our organization, the new plans, the new regime, the new hygiene rules, the essential changes in behaviour at work, the new or changed teams, the process changes, the revised critical points of hand-over and communication. Human factors are more important than ever.
Going back to our sports team analogy, the team and individuals also need to be fit. Now we are not expecting your workforce to be world-class sports people, but their work may well be physical to a greater or lesser degree. But what have your people been doing for the last three to four months? Some may have been on a fitness drive, but more likely is they have taken it easy. In short, their physical fitness may be compromised. The level of work they can now perform may need to be re-evaluated. You may need to have staggered or reduced work periods to allow them to build back up.
This is a lot for individuals and teams to deal with. It is a lot for managers and leaders to deal with. Everyone needs to be aware and alert to the issues. Good leadership and management will be crucial. Good, clear, honest communication. Don’t obfuscate or try to hide business concerns; they will see through it!
The dirty dozen
In human factors, the most well known are the ‘dirty dozen’. Each of these is, in effect, a risk that you need to manage. Let’s map these to all the above;
EASA (the European Aviation Safety Agency) has recently published a revised document on the role of operators' management systems in the COVID-19 recovery phase. It is interesting to note that this has a section on human factors. It says:
'Operations during the recovery phase may be affected by several organisational and human factors. Most staff will return to duty with a certain level of psychological stress, and operators should evaluate the need to provide targeted support in specific cases. Front-line staff may not feel "fit" for the duties but be willing to "go the extra mile" in order to support their organisation. Traditional human factor issues, such as distraction, can be exacerbated by COVID-19 related concerns and lead to slips, lapses and mistakes impacting critical actions, such as lowering the landing gear or arming/disarming the door slides. Just culture principles may be at stake, due to fear that in times of crisis, mistakes may be treated as wilful misconduct.' [4.3 Organisational and human factors aspects, The role of operators' management systems in the COVID-19 recovery phase]
An interesting statement. So let's see how this relates to the dirty dozen.
1. Communication. Failure to communicate clearly, fully and accurately at a process hand-over point, a shift change, can lead to an error or omission. We’ve established that workplaces may see new layouts, barriers to communication (both psychological and physical), and additional distances between workers. What’s the risk? Perhaps people won’t bother to go around the one-way circuit to pass on information or do shift handovers. Your once high-performing team may no longer be at their peak. How will you plan for and mitigate this? How will you brief your managers and people?
2. Complacency. This can come in many guises. Over-familiarity with a task, not recognising that part of the task or machine may have changed, or that skill-fade may have taken effect during time off. There may be a tendency to think, ‘we’ve never had a problem with that part, or this dimension, or that attribute before. No need to measure it or inspect it, I’ll just stamp it off.’
3. Lack of knowledge. The AS 9100 series has a clause; 7.1.6; Organizational Knowledge. It says (abbreviated form) that an organization ‘shall determine the knowledge necessary for the operation of its processes’, and that ‘this knowledge shall be maintained and made available’. This is particularly pertinent to the COVID-19 situation. In reviewing the organization context, strategy, risks, issues and formulating a new business plan, it may be that organization’s headcount requirements have changed, and the loss of staff can sometimes mean the loss of key organizational knowledge. ‘Old Fred can make that old CNC sing. But no one else knows that old programming language. Only Fred knows about the quirks of that grinder.’ So now you have a new person or team assigned to a task or activity. They lack key knowledge. What’s the risk? They may know that they lack knowledge and try to get on with the task as best they can, conscious of the pressures on the business and keen to show willing and safeguard their job, but may make mistakes, or they may just not know what they don’t know. Whatever the causal factors, lack of knowledge can lead to errors.
4. Distraction. This is often portrayed as being interrupted in a workflow by a colleague asking a question, a phone call, a manager changing priorities and telling a person to stop that and get on with this. All of these distractions are relevant here, but there may now be new distractions due to the new layout, the hygiene regime, remembering to wash hands or not touch things, or go around the new one-way circuit. Being conscious of the new behaviours or trying to remember to follow them.
5. Lack of teamwork. Back to Tuckman. Teams may have undergone enormous change due to people switching tasks and teams, or people absent due to furlough or redundancy. Some teams never reach the ‘performing’ phase, some individuals just don’t work well in teams. That is not necessarily a bad thing, but a manager needs to know his/her people, and assign them accordingly, monitoring and managing them back into an effective team.
6. Fatigue. We have already spoken about several contributing factors to fatigue; having to adjust to early starts, weeks of couch time if furloughed, lack of sleep due to stress or family situations. It’s crucial that workers look for the signs, both in themselves and their colleagues. You could instigate some good practice, such as exercise breaks; 5 minutes of stretching or jogging on the spot. Or you may consider a staggered return to work, or shorter shifts.
7. Lack of resources. This could be related to supply chain issues. How resilient is your supply chain, now and for the foreseeable future? With the pressure on, there may be a temptation amongst those unaware of the consequences (flight safety and product integrity to name a couple) to use a non-conforming part or component, or the wrong tool or measuring instrument. Are all your calibrated items available at the point of use? Are they in date? Lack of resource could also of course apply to people; Have you reduced the teams too far? Are there enough people to do the job?
8. Pressure. We mentioned before the pressure to get the job done. Time pressure, getting the job out the door to meet a customer demand may lead to steps or activities being missed or overlooked. Wanting to be on side, get things done, not be seen as the guy that stops work going out just because he was tired, or wasn’t happy with the result of that test, or didn’t have a calibrated torque wrench so used the engineer’s elbow. Pressure to keep one’s job.
9. Lack of assertiveness. Changes to teams, job-security concerns, pressures, and a lack of resources can all lead to a worker being assertive when required, leading to escapes.
10. Stress. We have talked extensively about a range of potential causes of stress. Stress can lead people to stop thinking and behaving rationally, to over-react, or fail to perform a task correctly.
11. Lack of awareness. New teams, new roles, new work processes, revised work orders, increased pressures. Are the revised routers or processes satisfactory? Have risks been identified and mitigated? Do they have control points? Have the writers made assumptions? Could a reader misinterpret an instruction? In the COVID-19 context, we could also add lack of awareness of the new hygiene regime. Consider that you have got everything up and running again, but one person failed to follow the social distancing rules and was a carrier. Instead of just one person being ill, your whole team could become ill. So these human factors can affect product, or the business as a whole.
12. Norms. Every organization has rules, and they tend to follow the 80-20 rule. There are 80% written or established rules, controls, methods etc. but there are some un-written rules too. Either of these can become a ‘norm’, but perhaps an incorrect norm. ‘We always do it that way, no need to follow the work card’. Add in all the above changes to people, teams, roles etc, and the norms may have worked for the old team, but the new folks don’t know how to make it work. They may establish new, unacceptable norms.
All change for the future
In summary then, there is a lot for leaders and managers to consider to ensure long term resilience following the COVID-19 pandemic. The big picture stuff, including context, strategy and business plans are obvious areas of focus, but always remember; your organization is nothing without people.
People are all different, they will all have had different experiences through the COVID-19 pandemic, and they will have been affected differently. A revised organization is different. Sites are different. Culture is different. The required behaviours are different.
Change, change, change.
All the changes can be for the better, but never overlook the importance of human factors and people as you make your plans and execute them.
Brendon Hill, Global Head of Aerospace
For more information, guidance and support materials as you navigate the next phase of recovery following COVID-19, visit our dedicated aerospace web page.
You can also follow my ‘Reopening and Rebuilding’ the Aerospace Sector podcast series here. Look out for the Aerospace playlist.
About the author
With over 40 years’ experience in aerospace and engineering Brendon leads the strategic direction of BSI’s aerospace sector. Brendon collaborates with industry bodies to drive innovation and is an international speaker, leading the way for a safe, secure future for the sector. Previous experience includes 26 years as a British Army Officer and Aircraft Engineer, both writing and implementing the quality management system and providing technical support to British Army aviation. He has also worked at a senior level in manufacturing in aerospace and other high-risk sectors.