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4 years on from Texas city_图文

4 Years On From Texas City 四年之后的德克萨斯城
Terry Welch
China Process Safety Symposium 中国化工工艺过程安全研讨会 May 9, 2009 2009年5月9日

Texas City Refinery March 23, 2005 2005年3月23日,德克萨斯城精炼厂 15 People Killed 15人死亡 Many more injured 多人受伤

Background 背景介绍
? 1997 getting Health, Safety and Environment right (gHSEr) established as BP’s HSE framework - benchmarked with industry peers 1997年,获得健康、安全和环境的权利(gHSEr)作为英国石油公 司(BP)的健康、安全和环境(HSE)的框架建立了起来——保 持同行标准 1999-2005 declining injury rates - among the best in the industry 1999年-2005年,受伤率得以降低——排在同行前列 March 23, 2005 – Texas City incident caused us to look deeply and urgently into what we can learn 2005年3月23日—— 德州事故引发我们的深思,并迅速从中 吸取教训 BP and CSB separately investigated the incident (BP report at www.bpresponse.org) BP和美国化工安全与危险调查局(CSB)分别调查该事故起因 (BP的调查报告,请参见网址www.bpresponse.org ) BP U.S. Refineries Independent Safety Review Panel (Baker) established at recommendation of CSB in October 2005. Note: Panel explicitly did not review the causes of the
Texas City accident.





BP美国精炼厂独立安全审查专门小组(Baker)在CSB的建议下于 2005年10月建立。注:该专门小组明确说明其并不审查上述德州事故的起因。 (Report at www.bp.com/bakerpanelreport) (调查报告参见www.bp.com/bakerpanelreport)


Texas City 3/23/05 Explosion - BP Incident Investigation

德州2005.3.23事故 - BP事故调查

The BP Report identified 4 critical factors and 5 underlying cultural issues: BP的调查报告明确了四项关键因素和五项根本文化因素:


? ? ? ? ? Insufficient business context 对化工行业安全方面的要求认识不足 Safety as a priority 安全第一的理念 Organizational complexity 组织架构的复杂性 Inability to see risk 对危险辨识的能力不足 Lack of early warning indicators 缺乏预警指示

? ? Start-up procedures and management oversight 开车程序和管理的疏忽 Loss of containment 遏制措施的缺失


Design and engineering of blowdown unit 排污装置的设计和工程 Control of work and trailer siting 工作的控制和临时拖车的停车位置的 选择

Incident investigation report available at: www.bpresponse.org 事故调查报告请参见:www.bpresponse.org


BP US Refineries Independent Safety Review Panel (Baker) Report BP美国炼油厂独立安全审查专门小组(Baker)调查报告
The purpose of the Panel was to assess the effectiveness of corporate oversight of safety management systems at BP‘s 5 U.S. refineries and to assess BP’s corporate safety culture. It did not seek to determine the root causes of the March 2005 incident at Texas City 该专门小组旨在评估BP在美国的五个炼油厂里对安全管理体系的公司监管的有效性,以及评价BP的公司安 全文化。但并未确定德州2005年3月爆炸事故的根本原因。
The Panel report, issued in January 2007, made recommendations in the following areas: 该专门小组的调查报告,于2007年1月公开,并在以下领域做出建议: 1. 2. 3. 4. 5. 6. 7. 8. 9. Process safety leadership 过程安全领导角色 Integrated and comprehensive process safety management system 一体化的综合的过程安全管理体系 Process safety knowledge and expertise Process safety culture 过程安全文化 过程安全知识和专门技能

Clearly defined expectations and accountability for process safety 对过程安全的确切的期望和责任 Support for line management Process safety auditing Board monitoring 对各级负责管理的支持 建立过程安全的领先和滞后绩效指标 Leading and lagging performance indicators for process safety 过程安全稽核 董事会的监管 行业领先者

10. Industry leader

Panel report available at: www.bp.com/bakerpanelreport 事故调查报告请参见:www.bpresponse.org


Texas City Site - what’s changed?

德州工厂 - 发生了什么变化?

? ? ?

New site Leadership Leadership training and support HSSE Team expansion

新的工厂领导班子 领导的培训和支持 健康、安全、保障和环境的团队扩充

? ? ? ? ?

Workforce engagement in “what you say matters” and “safe & reliable” action “人人参与”和“安全和可靠”的活动中员工的参与
Removal of trailers and relocation of personnel to new office buildings 拖车得以重新部署,员工搬迁到新的办公楼 Removal of blowdowns in heavier than air light hydrocarbon service and new flare systems 拆卸为比空气重的轻质碳氢化合物排污的设施,并建立新的火炬系统 Plant inspection and maintenance improvement programs 工厂的检查和维护改进项目 Control of work improvement program 工作改进项目的控制 Operating procedure improvements 操作程序的改进

? ?

Training/ learning and development enhancements
Process safety culture survey


New system for performance indicators 建立绩效指标的新系统 过程安全文化的调查


BP Group - what’s changed?
What’s Changed? 发生的变化
? ?

BP集团 发生了什么变化?

Executive leadership has fundamentally reviewed its strategic approach to operations 执行领导已经从根本上审核了运营战略方法 Founded on the global application of a new operations management system, based on continuous improvement & consistency through standardization 建立于新的运营管理体系的全球应用,基于标准化的持续改进和一致性

? Independent Panel Recommendations form part of this broader agenda 独立专门调查小组的建议构成了这个更广泛的议程的一部分
? Group Operations Risk Committee (GORC) gives line ownership: 集团运营风险委员会 ? Oversee performance & plans for consistent, safe, reliable operations 监管工作表现和工作计划,以保证一致、安全和可靠的运营

? Re-enforces senior executives emphasis on safe and reliable operations 加强高层管理人员在安全可靠的运营方面的监管
What has not Changed? 不变的是 ? Our HSE Commitment 对健康、安全和环境的承诺


Environmental and personal safety leadership



BP Group Learning - Way Forward
Immediate Action 立即行动 Plant 工 厂
Processes 过 程

BP集团的学习和进步 前进的道路
Deep Embedding 深化改革 Aspiration 终极目标

Six point Plan 六分计划

Temporary Accommodation Blow-down Stacks 暂时使用排放烟囱 Major Accident Risk 重大事故风险
Operating procedures 操作程序

Integrity Management & Control of Work 一体化的工作管理和控制

Operating Management System (OMS) 运营管理体系(OMS) ? sustained by the right organizational capability & culture 由恰当的组织能力 和文化支撑

Compliance 合规 Audit Actions 安全稽核行为

gHSEr 获得HSE的权利
Operations Competence 操作能力

World Class Operating Company 世界一流的 营业公司

People 人 员



Independent Panel Report 独立专门调查小组的调查报 告 - Implementation of Learnings across BP Group 调查报告结果在BP集团公司的实际执行
We have grouped learnings from the Panel’s 10 recommendations into 4 focus areas for BP Group: 我们为BP集团把专门调查小组的十条建议分为以下四方面:

1. Process safety leadership


(1) “process safety tone at the top”,”过程安全为首要问题” (5) “define expectations & strengthen accountability”, “明确期望并加强责任”(10) “industry leader” “行业领先 者”

2. Integrated and comprehensive management system 一体化的综合管理体系
(2) “system that systematically and continuously identifies, reduces, and manages process safety risks” ,”系统地、持续地识别、减少和管理过程安全风险的体系” (7) “leading & lagging indicators”, “领先和滞后绩效指标”(8) “audit”, “安全稽核”(9) “independent third party” ”独立第三方”

3. People 能

process safety knowledge and expertise


(3) “process safety knowledge and expertise”,”过程安全知识和专门技能” (6) “process safety support” “过程安全支持”

Independent Panel Report Learnings 独立专门调查小组的调查报告结果 - Process safety leadership 过程安全领导角色
? “Safe and reliable operations” is our number one priority. “安全可靠的操作”是首要问题 ? Executive Management and the Safety, Environment & Ethics Assurance Committee of Board of Directors visits to major sites / refineries 执行管理层和董事会的安全、环境和道德规范保证委员会在各主要工厂和炼油厂的巡查 ? Group Operational Risk Committee chaired by Tony Hayward meets regularly 由Tony Hayward 担任主席的集团运营风险委员会定期开会讨论 ? Senior executives attended Operations Academy executive session at MIT 高级管理人员参加麻省理工学院的运营学院的执行研讨会 ? New leadership appointments for Refining, Group & US Levels 在炼油厂、集团层面和美国公司任命新的领导层

? Performance contract and remuneration changes 建立绩效合同并进行报酬方面的改革
? Resources focused on operations 集中在运营方面的资源 ? Increased spending to improve integrity & reliability of US refineries 加大投入,以改进美国炼油厂的安全完整和可靠性 ? Front line deployment of experienced engineers to specific refineries 在个别的炼油厂,把经验丰富的工程师调度至第一线工作

? New S&O Audit team employs over 60 people 雇用60多人,建立了一支安全和运营审计团队
? Independent Expert reporting directly to Board appointed 独立专家直接汇报给指定的董事会成员

Independent Panel Learnings 组的调查报告结果 - Integrated and comprehensive system

独立专门调查小 一体化的综合体系

? Integrity Management and the Control of Work Group Standards are being implemented 一体化管理和工作组标准的控制已经正在实施
? Operating Management System (OMS) will deliver integrated and comprehensive process safety management system 运营管理体系将建立一体化的综合的过程安全管理系统 ? Site implementation plans at each U.S. refinery incorporate Independent Panel recommendations 在美国的每个炼油厂的工厂执行计划都吸取了独立专门调查小组的建议 ? Improved practices for risk management, incident reporting, & incident investigation 风险管理、事件汇报和事件调查的实践得以改进 ? Leading and lagging indicators ? New Group S&O audit 领先和滞后的绩效指标 新成立的集团安全和运营审计


Integrated and comprehensive system 一体化和综合的体 系 - OMS key concepts 运营管理体系的核心概念
Comprehensive Elements of Operating: 运营的综合因素
结果 运营的优先权 领 导 人 员 组 织 绩效 风 险 过 程 程 序 衡量、评估和 纠正措施 管理审核和 改进

Systematic management: 系统的管理
目标 风险评估和排列 优先顺序

计划和 控制

工厂 资产


实施和 运营

Consistently implemented ? 执行应始终如一?


Integrated and comprehensive system 系 - Process safety indicators 程安全指标

一体化的综合体 过

? BP is proactively involved in industry activity (e.g. API, CCPS and others) BP积极参加行业活动(如美国石油学会(API),美国化工过程安全中心(CCPS)以及其他组织) ? CCPS published recommendations for process safety leading and lagging metrics in December 2007 CCPS于2007年12月发布过程安全领先和滞后绩效度量的建议 ? API working on CSB recommendation for industry metrics API接受CSB的建议正着手建立行业度量标准 ? BP leading and lagging indicators already in use include BP已投入使用的领先和滞后绩效指标如下: ? Integrity management related incidents and high potential near-misses 完整性管理相关的事件和潜在的重大未遂事件 ? Major Accident Risk assessments 重大事故风险评估 ? Loss of primary containment 主要遏制措施的缺失 ? Overdue inspections & tests 延误的检查和测试 ? Open/overdue action items 未完成的/延误的行动项目 ? Process Safety Index based on Independent Panel recommendation 基于独立专门小组建议的过程安全索引 ? BP ongoing development of metrics consistent with industry guidance and “health of barriers” concept as per UK H&SE HSG 254 根据英国安全卫生委员会事务局(H&SE)的卫生安全管理指导原则(HSG)254的规定,BP正在 开发与行业指导原则和“健康障碍”概念相一致的度量标准

Independent Panel Learnings 独立专门调查小组 的调查结果 - Process Safety Knowledge & Expertise 过程安全知识和专门技能
? New Group and Refining Safety and Operations functional teams 新成立的集团和精炼厂的安全和运营功能团队 ? Head of Discipline approach 纪律责任负责人制度 ? Engineering Authorities 工程权力 ? Group Head of Operations has been recruited (DuPont) 已招聘运营集团负责人(杜邦) ? Group Process Safety Advisor & Process Safety Engineering team 集团过程安全顾问和过程安全工程小组 ? Refining VP Process Safety & Risk Management appointed (ex Dow) 已任命精炼厂过程安全和风险管理副总裁(之前在陶氏任职) ? US Head of Process Safety 过程安全美国负责人 New process safety fundamentals training 新的过程安全基础知识培训 Operations Academy established with MIT 与麻省理工学院共同建立的运营学院 Capability assessments of Operations leadership teams completed 已完成运营领导团队的能力评估 Process Safety specialists from consultants deployed in U.S. refineries 在美国炼油厂部署的来自咨询公司的过程安全专家 ? focus on action item closure 专注于行动项目的完成 ? acceleration of priority improvement programs 加快优先改进项目的进度

? ? ? ?


Independent Panel Learnings


- Process Safety Culture


? Group Operation Risk Committee commitment to build a culture that puts operations at the centre of everything we do 集团运营风险委员会承诺建立一种文化——以运营为中心
? Safety Culture Assessment and improvement process implemented at various sites. 在各个工厂执行安全文化评估和改进过程 ? Leadership support by external expertise at many refineries 在多个炼油厂的外部技术专家的领导支持 ? Independent Panel process safety culture findings shared with U.S. refining workforce and repeat cultural survey scheduled for 2008. 独立专门调查小组的过程安全文化的调查结果与美国炼油厂的员工分享,并再次进 行预定的2008年过程安全文化调查 ? Jointly developed, with United Steel Workers, a 10-Point Plan to improve safety. 与美国联合钢铁工人工会共同开发一个十分计划以促进安全的改进。

Summary - A personal reflection

小结 个人看法

Executive focus: 管理层的关注点 ? “Our number one priority remains safe, reliable operations and we made material progress in 2007 across all of the Baker Panel‘s recommendations. In 2009 I need you to continue to focus on safe and reliable operations.” CEO Mar ’09 Visible change: 明显变化 ? “A lot is going on” “还有很长的路要走” ? Removal of trailers & blowdowns and construction of new buildings and flares 迁走拖车和排污设施,重建办公楼和火炬 ? Increase in process safety resource and S&O support 增加过程安全资源的投入和安全运营的支持 ? New process safety indicators 建立新的过程安全绩效指标 ? Process safety measures in personal performance contracts 在个人绩效合同中加入过程安全衡量指标 ? Capability of line organization 直线集权型企业组织的能力 The ongoing journey: 下步计划 ? Immediate priorities based on risk reduction and restoring productivity of operational assets 立即执行降低风险和重新恢复运营资产的生产率的措施 ? Operating Management System (OMS) - the ‘BP way of operating’ 运营管理体系(OMS)——”BP的运营方式”

“我们的首要任务仍是安全可靠的运营,在Baker专门调查小组的建议的基础上我们在2007年做出了重大进步。2009年,我希望你 们仍然能够继续专注于安全可靠的运营”。 首席执行官,2009年3月


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