The Dutch Safety Board published a report on Schiphol’s aviation safety in April 2017. In this report, recommendations were made in order to address the identified safety issues.
The ISMS sector parties work together to follow-up on the Dutch Safety Board’s recommendations. The Schiphol Safety Improvement Roadmap contains, but is not limited to, the studies and measures which are necessary to implement the Safety Board recommendations. Depending on the results of the studies and outcomes of ISMS investigations, new additional measures that contribute to the follow-up of OVV recommendations will be added to the roadmap. Of the initial 31 measures, 14 measures have been implemented and will be evaluated in 2020. 6 measures were added since May 2018.
The concrete steps taken for each point will be detailed below.
You can expand the sections below for more details.
The development of the operational concept is taking place in conjunction with the Ministry of Infrastructure and Water Management, airspace users, the military, local residents, European partners and other stakeholders. The operational concept describes how humans, technologies and procedures are used to handle traffic at Schiphol. It is developed in a number of programmes in which the sector actively participates:
Changes to the operational concept are implemented in a number of smaller steps. Each step will be deemed safe prior to implementation, including their aggregation.
The sector is currently working on a number of structural elements to improve safety under the new operational concept, which include:
In response to concerns from the Dutch Safety Board, the sector has carried out an in-depth risk analysis in the field of runway combination changes in the current operation. A temporary task force has developed measures to further reduce the identified risks. Possible solutions that were identified are: better information about runway combination changes; optimisation of human factors and workload; better planning and later runway changes. In many cases, runway changes are made to comply with the system of ‘noise preferent flying’. The investigation has been completed and it has been possible to formulate measures that minimise the risks of runway combination changes, while at the same time continue to operate the noise preference system. These measures are now being executed. Meanwhile, the number of last-minute runway combination changes has decreased; we are monitoring whether this downward trend will continue.
The following items have been included in the roadmap and are now being implemented:
The measures taken should be robust for future developments including limited growth of traffic in the current operational concept. The runway change combinations study was verified by Helios, an external agency. In addition, the German Air Traffic Control (DFS) carried out additional verification on behalf of the Ministry of Infrastructure and Water Management (Ministerie Infrastructuur en Waterstaat).
A number of projects was carried out to reduce the complexity of the airport’s infrastructure.
The taxiway across the A4 motorway will be doubled. That means traffic can taxi via a double-ring which structurally reduces the airport’s complexity, which will result in the removal of a complex bottleneck at the airport. Furthermore, short-term safety improvements will be made within the current airport infrastructure to reduce risks.
The following items on the roadmap reduce the complexity of the infrastructure:
The crossing of active runways mainly concerns runway 06/24 (Kaagbaan) and 18L/36R (Aalsmeerbaan) due to the location of freight operations and aircraft maintenance activities in the hangars.
The ISMS partners carried out an in-depth risk analysis of crossing the Kaagbaan Runway (06/24). A temporary taskforce has now worked out a number of solutions to reduce the risk of crossing this runway at junction S2 (halfway across the runway). The number of crossings at S2 has decreased due to a decrease in air cargo at Schiphol. Furthermore, a decision was made to construct a crossing near the end of the runway, which avoids the high-energy part in the middle of the runway; this will reduce the risks further. We will take operational measures when the number of crossings would increase until these adjustments are ready.
Schiphol is expanding the Uniform platform where aircraft maintenance activities can take place without necessitating a runway crossing. In the ISMS, an analysis will be carried out as to whether the expansion of the Uniform platform sufficiently reduces the risk of crossings of the runway 18L/36R or that additional measures will need to be taken.
The following items to reduce the number of crossings are on the roadmap:
In total, LVNL monitors more than 20 parameters that relate to deviations in its safety management system. Relevant safety performance indicators based on operational data are periodically reported to management. This facilitates trend monitoring and, if deemed necessary, in depth analysis and corrective action. In order to further develop this system as recommended by the Dutch Safety Board, LVNL developed 5 additional safety performance indicators which were incorporated in 2019.
The prevention of risk accumulation will be formalised in the ISMS system. Risk accumulation will be considered in the periodic verification whether the declared capacity can be safely executed. Furthermore, the safety risks and associated mitigation measures of the changes in the past 3 years were analysed in the ISMS system as well. Although there was a potential for accumulation in several cases, it appeared that the organisations involved recognised the potential interference and took measures to prevent this (on a case-by-case basis).
The Runway Safety Team (RST) is a team of experts who identify the ways to reduce the number of runway incursions. Trends are continuously monitored to identify locations at the airport where runway incursions take place or have taken place in the past in order to prevent these situations from re-occurring in the future. This resulted in a number of ongoing studies and implementation projects, such as an improved procedure for crossing the Aalsmeerbaan runway, whereby runway incursions are prevented. In addition, NLR identified measures to reduce the number of runway incursions. To see an explanation of these measures, please refer to the NLR page.
In the ISMS structure, there is an executive chairman of the RST. That shifts the groups status from an advisory panel into an action-focused group. They will develop a plan to structurally reduce risks involved with runway incursions, which will include objectives and measures on how to reduce them. Compared to 2017, the overall total of runway incursions reduced significantly from 46 to 30 in 2018.
The following roadmap items reduce the risk of runway incursions:
Over time, new initiatives from the RST will be placed on this roadmap.
The integral investigation will be carried out in 3 ways:
The ISMS established a joint safety policy and critical success factors for ISMS in December 2018. This policy is defined in the context of the State Safety Programme: an integrated set of regulations and activities aimed at improving safety. A joint dashboard on interface risks was initiated in 2019. Further on, a joint strategic safety vision has been developed, which is currently being reviewed by the ministry of Infrastructure and Watermanagement.
5. Set-up an Integrated Safety Management System (IVMS) to which all of the parties in VPS are committed. This system must include at least the following elements:
The sector set-up an ISMS which jointly manages the safety risks associated with relationships and interactions between the individual parties. The Minister of Infrastructure and Water signed a covenant on the development of the ISMS. The ISMS mimics the structure prescribed by the ICAO and EASA for individual safety management systems. In January 2018, the first ISMS Safety Review Board Meeting took place. Two standing committees were also established; one is for flight operations and one for ground handling. These standing committees provide all parties at Schiphol with the opportunity to raise safety concerns, and to further address through risk analyses where necessary.
Since then, the following results were achieved:
The ISMS’ working processes are laid out in a manual that is updated annually.
The safety accountabilities in aviation are defined by regulations, most of which originate in European law and worldwide standards. In this context, it seemed legally impossible to give the ISMS (as the successor of VPS) formal authority over safety decisions, as parties are not allowed to transfer safety responsibilities. Decisions are instead made by consensus.
In order to ensure the effectiveness of ISMS, a number of measures were taken:
The above approach has demonstrably proven itself. Parties within the ISMS have made operational and strategic decisions about safety and have implemented these within the relevant companies. The ISMS is externally evaluated in a study conducted by the consulting bureau Baines Simmons in the United Kingdom in order to conform to the covenant. The results of this evaluation can be found here.