Transport & Logistics

Mixed signals: SPAD-risk management and mitigation from the Network Controller perspective

13 Apr 2018, by Amy Sarcevic

The term ‘SPAD’ (signal passed at danger) is often considered the ‘Voldemort’ of the rail industry. It represents one of the sector’s most ominous safety concerns, given the potential for high consequence accidents, loss of life, and severe reputational damage to the offending organisation.

SPAD violations have been attributed to a number of “human” errors, including miscommunication, misjudgement, distraction and fatigue – yet rarely do we interrogate the psychological theory underpinning these cognitive influences and explore the impact of the broader system around them.

Anjum Naweed is an Associate Professor and Certified Professional Ergonomist at the Appleton Institute for Behavioral Sciences in South Australia. Naweed identified the need for better psychological research into the teaming factors associated with SPADs and set out to acquire government funding to better understand them.

Naweed carried out extensive qualitative analysis, acquiring data from more than fifty train controllers across eight rail organizations, throughout Australia and New Zealand.

He instructed controllers to “invent” and analyse a hypothetical SPAD scenario in which the controller had inadvertently escalated risk, through either action or omission of action.

“I used this invention technique to get controllers to introspect on their own ways of working”, says Naweed. “Humans have a tendency to develop habits and cognitive short-cuts over time, which can make it very difficult for people in expert professions, such as Controllers, to even articulate what they do”.

While habits and cognitive shortcuts do have benefits, such as more efficient decision making, and less pressure on the attention span and mental resources, they do exploit “error” traps and other vulnerabilities in the system; as the findings have shown.

By encouraging the train controllers to externalise their knowledge, Naweed was able to extract a number of psychological factors and system biases that affected decision making, judgement and perception. He also identified some remarkable protective strategies that Controllers had developed to promote safety.

Naweed will present the preliminary findings of this research at the RISSB Rail Safety Conference – due to take place 9-10 May 2018 in Sydney.

The Conference will explore the risks associated with various rail operational models and systems, including a look at some of the very latest emerging technologies.

Learn more about the conference and register your place here.

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