Thursday, November 20, 2008
Knowledge in the bank
They say experience is the best teacher. Recognizing the value of experience, organizations ranging from the military to banks have placed lessons learned at the heart of their safety and performance improvement programs. The lessons learned concept focuses on collecting and analyzing operational experiences and making use of the resulting lessons in training and operations.
Analyzing events for lessons learned provides a basic tenet of many of the world's most progressive safety management programs, including those that focus on systematically addressing the root cause of most industrial accidents, especially human factors.
To that end, the Interagency Lessons Learned Center for Wildland Fire began operations in May 2002. The center's primary purpose is to improve the work performance safety and organizational learning for the entire interagency wildland fire community. The center focuses on research and analysis; knowledge management; and information transfer with the objectives of improving organizational learning and sharing knowledge to improve performance, safety and efficiency.
Goals and objectives
According to program manager Paula Nasiatka, the center accomplishes these objectives by collecting and analyzing observations, sharing lessons learned and best practices, archiving knowledge and information, assessing and evaluating learning and instructional methods, and incorporating lessons learned into the wildland fire training curriculum.
The center is located at the National Advanced Resource Technology Center in Marana, Ariz., and is supported by the Bureau of Indian Affairs, Bureau of Land Management, National Park Service, U.S. Forest Service, and the U.S. Fish and Wildlife Service under the guidance of the Federal Fire and Aviation Leadership Council.
Centers for lessons learned aren't new — the U.S. Army, Navy, Air Force and Coast Guard all maintain sophisticated programs, as do the Canadian army, the National Aeronautics and Space Administration, the U.S. Department of Energy, and organizations as diverse as the United Nations and the National Endowment for the Arts.
The wildland fire center originated with recommendations from both the Business Practices Re-Engineering study of NARTC and TriData Corp.'s Wildland Firefighter Safety Awareness Study, both of which identified a need for the center. The NARTC study found that an organization designed to collect and disseminate lessons learned could be a highly valuable component of a safety program for the agencies participating in the study, and in 1998 TriData recommended that the five federal agencies involved in wildland fire establish a center for lessons learned, using the Center for Army Lessons Learned as a model.
In many respects, the U.S. Army's Center for Army Lessons Learned at Fort Leavenworth, Kan., provides the gold standard for lessons-learned programs and serves as a proven model from which to design a wildland fire program. The wildland center staff also examined the Department of Energy and Coast Guard programs and intends to evolve the program as necessary to appropriately serve the wildland fire community.
Information collection teams
The center collects and receives information and data from a variety of sources, including information collection teams and after-incident reports. The center will use small ICTS of two to three people to gather data and make observations on the incident ground. The ICT reports to NARTC, but the team also remains available to assist incident management teams and field units as issues are identified.
The ICT gathers information pertinent to tactics, techniques and procedures on a variety of issues that are identified through the lessons learned program. Once collected, the Marana-based center staff will analyze the data and use it to update incident management teams, fire crews, and other field units on what lessons are being learned in the field and how tactics can be applied. The center also will share team reports with course instructors and developers to ensure that training courses are teaching procedures that work on the incident ground.
ICTS don't evaluate, review or assess the incident management team or the performance of crews or individuals. The team's purpose is to collect data on tactics, techniques and procedures for the purpose of sharing knowledge and lessons learned with field units and the training cadre.
The lessons-learned program focuses on safety issues, training and learning, not the creation of policy. While the information collected by ICT may become the catalyst for policy change, the principal purpose of the ICT is to collect information on how units, teams and individuals are overcoming the problems they face.
After-incident reports
The center makes use of after-incident reports to collect information from individuals and incident management teams. The report format identifies a problem or issue and what steps were taken to overcome the problem on the given incident, providing a self-service means by which individuals and teams can submit information pertinent to tactics.
In addition, the center also will use the reports to identify unresolved issues that an ICT can look for and address on subsequent assignments. The staff of the center anticipates that the reports may uncover trends or common problems that have not been adequately addressed.
Center staff members hope the reports will be used to identify what is working as well as what needs improvement. The staff also believes that, through the free-flowing nature of the report, it may be possible to identify and resolve safety and performance problems without creating additional policies.
Lessons learned and best practices are gathered and analyzed at the center, organized and archived for use, and publicized or transferred to the incident management community via the training curriculum, the Internet and other media.
The lessons-learned center staff is developing an electronic database of lessons learned and best practices available on their Web site, http://wildfirelessons.net. The center also shares information with the field via a quarterly e-mail newsletter called Scratchline and a tool known as the Winning Series, which provides a collection of tactics, techniques and procedures that have been proved to work in specific parts of the country or on certain types of incidents. The Winning Series will address tactics for command, operations, safety, logistics, planning, finance and information.
The intent of the quarterly Scratchline, first published during the summer of 2002, is to get information into the hands of the people who need it quickly and in a simple format. The main purpose is to inform and educate the reader with articles that discuss new techniques, tactics and procedures. The newsletter also will provide information on other sites or publications of interest.
In the future, Learning Curve will supplement Scratchline monthly during the fire season. Learning Curve will report the most timely and useful lessons learned and best management practices from after-incident reports as they come into the center. Program Manager Nasiatka has used the process behind Learning Curve as her way of synthesizing the information contained in the AIRS as they come in. “Now we will use the Learning Curve to return that synthesized information back out to the field quickly during the fire season,” she says.
The center will make the series available on its Web site for individuals and teams as they are dispatched to incidents throughout the country. For example, an individual will be able to go to the NARTC Web Page, click on “Lessons Learned,” click to the “Winning Series” and then click to the part of the country where the incident is or for the type of incident they are reporting to, such as “Winning in the Southwest,” “Winning on Hurricanes,” or “Winning with FEMA.” The entire document or just sections of it may be downloaded.
The Winning Series will be created in collaboration with subject matter specialists who have experience in specific regions of the country. It will not only point out techniques that work well in each region, but it also will alert personnel to potential problem areas.
A work in progress
In its first four months of operation, center staff compiled lessons learned and tips on best practices from more than 50 reports. According to Nasiatka, this is just a beginning, and users will see nearly continuous developments as the staff meets its short-term and long-range goals.
In the near term, planned developments include numerous enhancements to the program's centerpiece Web site. Dave Christenson, the program's assistant manager, will guide the site enhancements. They include:
- Online access to reports and the ability to retrieve them;
- Hot Tips, a method of reporting innovative techniques, tactics, equipment and job aids;
- Online access to the Winning Series collection of region-specific lessons and practices;
- Online access to Learning Curve; and
- A searchable online resource library of important reference materials.
The online resource library represents a significant advance in that it will provide a tool to find links and documents including technical publications, presentations, periodicals, reviews and white papers at a single, searchable source.
Also in the near future, the center's staff will develop additional ways to communicate lessons learned and best practices to the field-level firefighter. “We know that the Web site is just one avenue for sharing this information,” says Nasiatka.
Development of a lessons-learned database represents a significant program goal in the short term. The initial information for this database exists through the efforts of ICT that were in the field during the past fire season and by compiling more than 50 reports. The center will employ the database to collect, store and categorize lessons learned and best practices for future access.
State and municipal cooperation
The unprecedented 2002 wildfire season also produced exceptional mobilization of municipal fire departments to wildland fire duty. Consequently, municipal fire chiefs should take note of three key lessons learned from the 2002 fire season. These include:
- Filling the liaison officer position
A local Office of Emergency Management coordinator can make an excellent liaison officer for an incident management team. On one recent incident this coordinator, who knew all the local leaders, focused on improving relationships with local government that were strained at the time. The human relations skills of the OEM coordinator and his local knowledge was critical to the successful completion of the assignment.
- Using local expertise
Local resources can have excellent knowledge of the area fire behavior, including unique wind patterns and local fuel conditions. Incorporating their knowledge of these factors into the strategy can have a significant impact on containing the fire. It's important to identify who these resources are as soon as possible and use their expertise during all phases of the incident.
Standardized procedures are needed regarding how state and municipal resources will be used on incidents. Individuals in these groups don't always carry proof of their ICS qualifications. A way of addressing this in California is for everyone to carry a fire qualification letter signed by their fire chief that attests to his or her Red Card qualifications.
Also of interest to municipal fire chiefs will be the unique lessons from incident management teams assigned to the World Trade Center disaster in 2001. Four Type I incident management teams, principally organized to respond to complex wildland fires, were dispatched to New York to support the FEMA incident command post, the Fire Department of New York incident command post, and responding agencies and personnel working at the World Trade Center site.
These teams, with the assistance of center staff, captured important lessons in the areas of planning, logistics, operations, finance, information and safety. The process of compiling the lessons learned by the teams sent to New York represents an important learning experience for the center's staff, as the program may be expanded to include all risk management in the future. Among the recommendations:
- Each section chief and unit leader needs to pay extremely close attention to their personnel for signs of stress. A means for debriefing is necessary on-site and back at the home unit.
- Incident management teams should be aware that picture identification is a necessity.
- When operating in urban areas, a meeting to coordinate all emergency services communication needs to be scheduled early on. More than 100 UHF and VHF radio systems were in use at the World Trade Center.
- Incident management teams need training on the FEMA operational structure, including its mission, organization and ordering procedures.
- Finance chiefs must receive clear instructions on specific procedures required by FEMA.
- The process to obtain permission for interviews was lengthy and often required more time than media representatives could afford.
- Not all people are suited for a disaster assignment. The reality of the situation will have greater impact on some team members than they may anticipate.
- Patience is a must, particularly when working with agencies that have a long tradition of self-reliance, especially when they have lost personnel, equipment and facilities.
A more detailed account of these recommendations appeared in the first issue of the Scratchline newsletter and are posted at the center's Web site, as are other compiled lessons from the 2002 wildland fire season.
Michael DeGrosky is the CEO of the Guidance Group, a company providing strategic services to fire and emergency organizations, and a former member of the International Association of Wildland Fire Board of Directors. He is currently pursuing a master's of Organizational Leadership at Fort Hays State University.
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