Re: TMI root causes -Reply

["Sandy Perle" <sandyfl@earthlink.net>]

Roy Craft said:

> One of the supposed changes in operations as a result of TMI and of
> SL-1, was that procedures did not cover all possible sequences of
> events, and that basic knowledge of systems and processes must be
> understood by the operators.  That was put into effect as more procedurs
> with absolute compliance required. We really need more people to
> understand why the procedural requirements are there, rather than blind
> acceptance to a preconceived idea of what should happen.

Yes. Definitely. Procedures and training of individuals assigned the 
accountability of working with processes that have serious 
consequences really need to know the "why" of what they do, and the 
consequences for when the "what" isn't followed as specified. In the 
design of systems, it is imperative that EMEA and FMEA techniques be 
used to determine what can go wrong, design safety features to 
mitigate the potential, and ensure that procedures contain enough 
contingency planning to assist the individuals performing the tasks. 
TMI did result in better "human factoring" when designing systems. 
Now we must ensure that this continues to be the process, and keep 
drilling and training to ensure a thorough working knowledge. As 
always, I want to reiterate that PROCESS CONTROL and SYSTEMS are the 
keys to everything. Only positive management can ensure this.
------------------
Sandy Perle
Technical Director
ICN Dosimetry Division
Costa Mesa, CA 92626
Office: (800) 548-5100 x2306 
Fax:    (714) 668-3149
  
sandyfl@earthlink.net
sperle@icnpharm.com

Personal Website: http://www.geocities.com/CapeCanaveral/1205
        
ICN Dosimetry Website: http://www.dosimetry.com

"The object of opening the mind, as of opening 
the mouth, is to close it again on something solid"
              - G. K. Chesterton -