Article

A Revisit to the Recent Human Error Events in Nuclear Power Plants Focused to the Organizational and Safety Culture

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Abstract

Objective: This paper presents additional considerations related to organization and safety culture extracted from recent human error incidents in Korea, such as station blackout(i.e., SBO) in Kori#1. Background: Safety culture has been already highlighted as a major cause of human errors after 1986 Chernobyl accident. After Fukushima accident in Japan, the public acceptance for nuclear energy has taken its toll. Organizational characteristics and culture became elucidated as a major contributor again. Therefore many nuclear countries are re-evaluating their safety culture, and discussing any preparedness and its improvement. On top of that, there was an SBO in 2012 in the Kori#1. Korean public feels frustrated due to the similar human errors causing to a catastrophe like Fukushima accident. Method: This paper reassesses Japan's incidents, and revisits Korea's recent incidents. It focuses on the analysis of the hazards rather than the causes of human errors, the derivation of countermeasures, and their implementation. The preceding incidents and conclusions from Japanese experience are also re-analyzed. The Fukushima accident was an SBO due to the natural disaster such as earthquakes and a successive tsunami. Unlike the Fukushima accident, the Kori#1 incident itself was simple and restored without any loss and radioactive release. However, the fact that the incident was deliberately concealed led to massive distrust. Moreover, the continued violation of rules and organized concealment of the accident are serious signs of a new distorted type of human errors, blatantly revealing the cultural and fundamental weakness of the current organization. Result: We should learn from Japanese experiences who had taken pride in its safety technology and fairly high confidence in safety culture. Japan's first criticality accident in JCO facility splashed cold water on that confidence. It has turned out to be a typical case revealing the problems in the organization and safety culture. Since Japan has failed to gain lessons and countermeasure, the issue persists to the Fukushima incident. Conclusion: Safety culture is not a specific independent element, which makes it difficult to either evaluate it properly or establish countermeasures from the lessons. It may continue to expose similar human errors such as concealment of incident and manipulation of bad data. Application: Not only will this work establish the course of research for organization and safety culture, but this work will also contribute to the revitalization of Korea's nuclear industry from the disappointment after the export contract to UAE.

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... Such typical cases include the space shuttle Challenger and space shuttle Columbia accidents (Stanton et al., 2010). Wrong safety culture is also recognized as a major cause in the accidents occurring in nuclear power plants.Fukushima Nuclear Power Plant accident or Gori Nuclear Power Plant SBO accident can be representative cases (Lee, 2013). The organization members from various management level of each nuclear power plant were recruited to sample interviewees. ...
... To point out the organization's recent problems on safety, the questions need to be updated periodically to identify the opinions on the recently occurred critical accidents. As pointed out by Lee (2013), the accidents occurring in a highly reliable nuclear power plant are rare in frequency. Therefore the accident experiences should be treated valuably, and should be reflected in the safety culture evaluation. ...
Article
Objective: The aim of this study is to suggest some improvement ideas based on the validity and the reliability analyses of the current safety culture measurement method applied to the Korean nuclear power industry. Background: Wrong safety culture is known as one of the major causes of the disasters such as the space shuttle Columbia disaster or the Fukushima Nuclear Power Plant accident. Assessment of safety culture of an organization is important to build a safer organizational environment as well as to identify the risks hidden in the organization. Method: A face validity of the current safety culture measurement method was analyzed by comparison of the key factors of safety culture in the Korean nuclear power industry with those factors reviewed in the previous studies. The current interview method was analyzed to identify the problems which degrade the consistency of evaluation. Results: Most safety culture factors reviewed in the literatures are covered in the list of the Korean nuclear power industry safety culture factors. However the unstructured questions used in the interview may result in inconsistency of safety culture evaluation among interviewers. Conclusion: This study suggests some examples which might improve the consistency of interviewers` evaluation on safety culture such as a post interview evaluation form. Application: An extended post interview evaluation form might help to increase the accuracy of the interviewing method for Korean nuclear industry safety culture evaluation.
Article
The importance of safety culture has been emphasized to achieve a high level of safety. In this light, a systematic method to more properly deal with safety culture is necessary. Here, a decision-making tool that can apply a graded approach to the analysis of safety culture is proposed, called the F-D matrix, which determines the frequency and the difficulty of safety culture attributes recently defined by the IAEA. A hierarchical model of difficulty contributors was developed as a scoring standard, and its elements were weighted via expert evaluation using the analytic hierarchy process. The frequency of the attributes was derived by analyzing reported events from nuclear power plants in the Republic of Korea. Period-by-period comparisons with the F-D matrix can show trends in the change of the maturity level of an organization's safety culture and help to evaluate the effectiveness of previously implemented measures. In the evaluating the difficulty of the attributes in the recently developed harmonized safety culture model, the difficulties of Trending, Benchmarking, Resilience, and Documentation and Procedures were found to be relatively high, while the difficulties of Conflicts are Resolved, Ownership, Collaboration, and Respect is Evident were found to be relatively low. A case study was conducted with an analysis period of 10 years to attempt to reflect the many changes in safety culture that have been made following the Fukushima accident in March 2011. As a result of comparing two periods following the Fukushima accident, the overall frequency decreased by about 40%, providing evidence for the effects of the various improvements and measures taken following the increased emphasis on safety culture. The proposed F-D matrix provides a new analytical perspective and enables an in-depth analysis of safety culture.
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