Journal of Accident Investigation

CHARLES H. SIMPSON
and controlled records had been eroded, making it increasingly
difficult to access the right information in a timely manner.
Information technology tools were amassing increasing amounts
of information but were not designed to manage it in an
enterprise-wide fashion. In short, technology was contributing
to the problem, not helping to solve it. It was apparent that if
the gaps were not dealt with in a substantive way, the strength
of the TSB’s product, quality information, would be weakened,
its credibility would be negatively impacted, and its value to
Canadians would diminish.
The challenge, of course, was how to address the problem.
Like most safety investigation agencies, the TSB is relatively
small with modest resources dedicated almost entirely to
supporting day-to-day operations. Any commitment to address
the information management shortcomings in a sustainable
manner would require a substantial deflection of human and
financial resources over a protracted period of time.
Convinced of the long-term imperative, the TSB embarked
upon a project to develop an integrated IM/IT platform to
support the organization and, in particular, our investigation
teams. Known as the TSB Investigation Information
Management System (TIIMS), the goal is to implement an
integrated set of documents, content, records, cases, workflow,
forms, and project management practices and tools. Another
notable feature of the system is the development of a Reference
Centre that will consolidate those often hard-to-find policies,
guidelines, operations manuals, checklists, and other reference
tools into a single area for easier access. Accomplishing this
goal will require a major effort of employees who are already
busy with their normal functions. “Buy in,” particularly amongst
managers, and the recognition that people and substantial
financial resources would have to be diverted full-time to this
undertaking, were the two first critical hurdles to overcome.
Indeed, two and a half years into the project, they are never far
from the surface.
Two other fundamental decisions concerned the software
tools and the methodology to be employed in the project. The
first was relatively straightforward; a small agency would never
be able to afford development of new software from the ground
up. A team-oriented plug and play environment was required
and for that, Microsoft’s Sharepoint Portal and Services products
were chosen as the foundation pieces.
The change management tool employed is based upon
the use of business reference models. These models provide
a common description of, and context for, an organization’s
business practices. They are used to facilitate user consultation,
to manage project scope, and to assist in the transition to the
new practices and tools. The effort required to develop and
obtain agreement with these models is considerable but, without
that foundation, the development of an integrated information
system would be impossible. In particular, their use leads to a
standardization of practices and terminology that can only
strengthen the organization in a variety of ways. However, in
the early stages of the project, these eventual advantages were
not apparent to everyone and sustaining momentum required
ongoing effort.
The essential problem with our current system is that
automated investigation tools, data systems, document
management, and the various business practices by which
information products are produced and stored are not
connected. This results in multiple entry and information
collation challenges that are not only time consuming but
also create the risk that information will not be available for a
specific requirement at the right time.
The new platform will replace the TSB’s current Intranet and
will comprise a hierarchy of gateways or portals and pre-defined
investigation workspaces (figure 1). The gateways will be
primarily information based while the investigation workspaces
will organize and integrate the many tools needed by our
investigation teams. Since it is recognized that the system will
evolve with time, the approach has been to build the system in
modules so elements can be easily added, removed, or modified
and to establish the appropriate governance tools needed to
manage these changes.
As part of the development and implementation process,
a series of pilots has been undertaken, using real-life
investigations, to validate the new tools. This approach
maximizes input from those for whom the workspaces are being
developed, thereby enhancing the potential for buy-in and
successful implementation. The objective is to have the first
version of the new system in operation by the end of March
2006. Other modules remain to be developed and incorporated
in the following year(s). Nevertheless, we are confident that
most of the critical gaps identified in our risk assessments will
be resolved or significantly remediated by the first operating
version; identified risks will have been substantially reduced.
There is one other key decision that has been required
to optimize the probability of success for this project. The
individual accountable for the developmental aspects of the
system cannot be expected to also manage the transition to, and
permanent operation of, that system. Therefore, the TSB has
assigned those responsibilities to a full-time operations manager,
once again from within current resources. It would be tempting
to ignore this additional commitment simply because of its
short-term impact on current activities. However, for an
undertaking as fundamental and far-reaching as this, it would
be unrealistic to assume that once development is “complete,”
transition and steady-state operations would automatically fall
into place.
6 NTSB JOURNAL OF ACCIDENT INVESTIGATION, SPRING 2006; VOLUME 2, ISSUE 1