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key performance indicators aiming at monitoring the safety performance at national level.
3.6.6 In line with this performance-based approach, and in addition to the minimum
requirements of ICAO to monitor safety performance at State level, the new SES II
legislation establishes, through its SES II Performance scheme and the extension of
EASA responsibilities to ATM/ANS airports, a new mechanism to monitor safety
performance at both service provision and State level through continuous ANS safety
performance monitoring and Standardisation inspections of each EU Member State.
Under this new approach, the PRB, EASA and all EU Member States shall closely
cooperate with ICAO CMA to enhance safety in the EU airspace.
3.7 Just Culture
3.7.1 Just culture is a key element to enhance safety levels in all areas of aviation. It is a culture
in which “front line operators or others are not punished for actions, omissions or
decisions taken by them that are commensurate with their experience and training, but
where gross negligence, wilful violations and destructive acts are not tolerated.”9 For the
last decade EUROCONTROL has initiated a number of activities aiming at improving
just culture in its Member States, including development of guidance material, awareness
campaigns, training of personnel and development of local implementation safety
objectives in support to air navigation service providers and ANS regulators. However,
not all the States have taken the necessary measures to overcome legal and cultural
differences to achieve a fully non-punitive reporting system.
3.7.2 The implementation and measurement of safety indicators is only possible with a nonpunitive
and learning environment that allows for the collection of reliable and concrete
safety data. All States concerned should have an appropriate legal structure to enable
harmonised safety measurement and reporting.
3.7.3 Such inclusive and open reporting forms the basis for developing measures to enhance
safety levels. Development of a just culture throughout the ECAC area should be a
priority in every State.
3.7.4 In 2009 EUROCONTROL Member States have reported, through their Local Single Sky
Implementation programme (LSSIP) the level of establishment of national arrangements
for the implementation of a reporting and investigation system in a Just Culture
environment. Figure 34 shows the status of implementation of Just Culture environment
in ECAC Member States based on the self-assessment reports of each State. Only 19
EUROCONTROL Member States have reported full implementation and 10 have
reported partial implementation. Six member States have planned the implementation,
with expected completion by end 2010. Only one State (Ukraine) is late, with another one
(Montenegro) not providing any information. The remaining ECAC Member States are
either late or have not yet reported the status of implementation of Just Culture
environment.
9 In the absence of an ICAO agreed definition, the EUROCONTROL definition has been used. New definitions
will be proposed in the context of the High Level Safety Conference (see § 3.7.5).
PRR 2009 Chapter 3: Safety
25
3.7.5 Just culture was considered at the European Commission High-level Conference, held in
Madrid (February 2010). The Declaration of Madrid, inter alia, states that the
“participants to the Conference acknowledge the necessity to […] build the performance
scheme on a genuine safety culture, integrating effective incident reporting and ‘just
culture’ as the basis for safety performance”.
3.7.6 The EU also presented a paper to the ICAO High-level Safety Conference to improve
reporting and interaction between safety and judicial authorities. This has a direct bearing
on Just Culture and the proposal to establish an ICAO Task Force on Open Reporting
offers the prospect of wider and more consistent safety reporting.
3.7.7 Moreover, the extension of EASA’s competence into ATM/CNS and Aerodrome will
result in many of the rules and Standards applicable to aircraft operations becoming
mandatory for ATM. A ‘culture of safety’ exists in EASA regulations as does the basic
requirements for a just culture. Close coordination between EASA and EUROCONTROL
(SRU/PRC) is needed to develop rules that enhance the reality of an Open reporting
culture in European ATM.
Figure 34: Implementation of Just Culture environment in 2009
3.8 Transparency and sharing of safety information
3.8.1 The degree of transparency of safety-related information to the general public varies
widely across Europe. While some States make a whole range of safety data publicly
available, including safety oversight audit results and State corrective actions, others limit
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Performance Review Report 2009(26)
