(42f) Utilizing a Digital Process Safety Game to Improve Training Strategies in Pilot Plants

Aside from the development of new process technologies, laboratories and pilot plants cultivate an environment where improved training practices can be implemented and refined, due to the high level of safety standards required in pilot scale plants. Current training methods used to manage process safety risks include process hazard analyses (such as operability studies and what-if checklists), and risk assessments (such as hazard and operability (HAZOP) and layers of protection analysis (LOPA)). These analysis methods rely on the use of engineering judgement and expert opinion, however, these analyses are not free from the influence of heuristics and cognitive biases that come along with human judgements (Baybutt, 2018). Biases can lead to blind spots when making judgements, where an individual’s beliefs about how they will react does not reflect the behaviors that actually take place (Bazerman & Tenbrunsel, 2011). When our beliefs and behaviors are not in alignment, our resulting behavior may be uninformed to potential consequences. Blind spots can also be caused by the lack of recognition of external pressures, and how they impact judgements, sometimes contributing to the occurrence of process safety incidents.

External pressures, such as productivity, money, and reputation, can impact judgements that result in process safety incidents. As described by the Chemical Safety Board (2023), there have been several instances that reflect these types of occurrences. For instance, in 2014, Freedom Industries chemical storage and distribution leaked crude MCHM and polyglycol ethers into a river that impacted drinking water for the surrounding nine counties. The CSB investigation found no documentation of inspections or maintenance on the tank that leaked, and that the secondary containment surrounding the tank had been deteriorated. While the company knew the costs to repair these items, they had not moved forward on a project to make the changes. Another example is from the Chevron refinery fire in Richmond, California that resulted in a chemical leak which eventually ignited to a fireball, injuring six employees and causing 15,000 people in the surrounding area to seek medical treatment. During the investigation, the CSB found that the leak originated from a section of an insulated pipe that had been flagged twice for maintenance. The plant was aware of this, but continued to run the process until they could pinpoint the leak, which eventually resulted in the chemical release, and consequent explosion (CSB, 2023). Incidents like these suggest that other criteria such as money, down-time, and production are influencing process safety judgements, and are taking precedence over safety.

Previous work suggests there are six competing criteria that may impact process safety judgements. These six criteria are: safety, time, production, spending, leadership, and relationships. For example, in the Freedom Industries leak, safety was sacrificed for the cost to repair the secondary containment, and the time to complete the inspections and maintenance on the tanks. Whereas, the Chevron Refinery fire shows the prioritization of production and time over safety, by not repairing the leak on the pipe which resulted in the fire and explosion. For these reasons, it is important that industry professionals are aware of competing criteria when approaching process safety judgements.

In order to study how these competing criteria compare to one another when making process safety judgements, we use the game-based learning environment Contents Under Pressure (CUP). CUP is a professionally developed game where participants play the role of a chemical plant manager facing an impending hurricane. Within the game, participants are able to make authentic safety judgements, without the associated risks. Over the course of 15 simulated game days, participants make a series of process safety judgements which impact metrics such as time, safety, reputation, and plant output.

Research indicates that a way to mitigate poor judgements could be to engage individuals in self-reflection about any gaps that exist between their beliefs and performed behaviors. A pilot study was conducted in spring 2023 to determine the differences that may exist between the beliefs and behaviors of industry professionals when approaching process safety judgements. Five industry professionals with engineering backgrounds who work in the chemical process industry were recruited for the study. The methodological approach for this study collected practitioner beliefs (pre-CUP interview), simulated behaviors (CUP), and reflection (post-CUP survey) through ranking the competing criteria from the conceptual framework. This allowed researchers to directly compare any gaps that existed between participant beliefs and behaviors.

We anticipate this work will help raise awareness of approaches to process safety judgements and will also generate conversation on how to build on current training approaches to include consideration for the impacts of competing criteria on process safety judgements. Implementing new or improved training strategies in laboratories and pilot plants can assist in refining these strategies, before rolling them out to larger production plants. This increase in awareness can help mitigate the occurrence of process safety incidents related to engineering judgement in the future.