It is a truism that in relationships, it’s the little things that we can’t ignore. Whether it be one partner never putting the kettle in the same place in the kitchen twice, or the other not folding the laundry in proper way, seemingly small things can grow to disrupt the relationship to the point of a breach or breakdown until the underlying issue is address.
As it goes in relationships, so it goes in energy and business; the world is only too full of examples of where a failure has propagated from a small beginning to escalate into a critical failure of a component or business relationship. One of the most dramatic examples of this was the catastrophic explosion of the Space Shuttle challenger 73 seconds into flight on January 28th, 1986. An FKM rubber O-ring with a cross section of only 7.1mm, which had stiffened in the cold was the root cause of the incident; with it failing to seal and allowing the release of high temperature gas from the Solid Rocket Boosters (SRB), the super-heated gas plume burned through the wall of the main external tank, causing it to rupture and explode, destroying the vehicle and killing all onboard.
Further investigation would later point to cultural failings and a breakdown of the relationship between Nasa’s engineers and Managers, and between Nasa and the manufacturer of the SRBs Thiokol; The little things in this case were very much ignored, in the very literal and tragic sense.
The risk I wish to highlight by considering this case is that routine checks become just that: Routine. When we consider the propagation of small failures that lead to disproportionate outcomes, we should do all we can to ensure the rigorous application of our procedures and processes, which are the best defence against such a situation arising. Alongside these we should seek to feedback to process owners any improvements that we can identify to further reinforce the robustness of our checks system to protect ourselves and our customers as much as is possible. Eliminating the little things will help ensure the best working environment for ourselves and all around us to ensure everyone who works safe, goes home safe at the end of the day.
- Derek Scott, Quality Manager (Europe & AMEC)