A Risk management framework for safer decision making

Guiding engineers through a structured approach to identify, assess, & prioritise risks to make less conservative decisions.

Confidential

9 months

Oil & Gas

Lead Product Designer

  • User research

  • MVP definition

  • UI Design

  • User testing

  • QA

Product Designer

Product
Designer

  • Problem/user research

  • Ideation & solution design

  • UX/UI design

  • Backlog management

  • Stakeholder Engagement

  • Product operation

  • Continuous improvement (dual track)

Product Owner

3 in-house developers

Workflow Designer

Jr Service Designer

Process Safety Eng

Scrum Master

System Architect

Change Manager

Value Engineer

Problem

Problem

Process Safety Engineers were making overly conservative risk management decisions leading to excessive spending for minimal risk-benefit.

Process Safety Engineers were making overly conservative risk management decisions leading to excessive spending for minimal risk-benefit.

Goal

Goal

To reduce the amount of resources spent on low-value risk management activities.

To reduce the amount of resources spent on low-value risk management activities.

Solution

Solution

A web-app, combined with a new training framework & process for making risk management decisions.

The web-app aimed to guide engineers through the decision making process.

Discovery

2

Focus groups

21

Interviews

4

Ethnographic
walk-throughs

17

Survey
respondents

What we found…

01

02

03

04

Procedural biases reinforce ‘create-an-action’ culture

Procedural biases reinforce ‘create-an-action’ culture

01

The path of least resistance is progressing with actions

The path of least resistance is progressing with actions

02

People are driven to protect themselves from retribution

People are driven to protect themselves from retribution

03

There is an inconsistent understanding of risk

There is an inconsistent understanding of risk

03

"They don't always have the right information in the room, so it often needs updating later"

- Engineer

“It's so hard to decipher exactly what's going on [in the pdf document]”

- Maintainer

I don't markup LOPA. It is too much effort.

- Maintainer

"It's not just getting to tolerable risk, if you can get it lower, you should do that"

- Engineering Manager

- Engineering Manager

"It's easier to justify an action than justifying ALARP"

- Process Safety Engineer

- Process Safety Engineer

"We wear the risk when an event happens"

- Senior Engineer

- Senior Engineer

"We over complicate what ALARP is - we misuse the framework"

- Engineering Manager

- Engineering Manager

Current State Map

The draft current state was built collaboratively with our SME & design team then validated, built upon & refined during research activities.

We developed one that focused on high level steps, time frames & key pain points; & another that went into more detail.

Current State User Journey Map — Images blurred for confidentiality

Root Cause Analysis

To really understand the root cause of the problems & pain points, I conducted a 5 why's analysis. These diagrams were split into the 2 identified improvement areas.

Since the problem space had a lot of cultural influences, this activity really helped us get to the bottom of why we were seeing certain behaviours & outcomes.

Root cause analysis

Design

Solution Ideation

We used a variety of methods to gather solution ideas:

  • Ideation sessions with users & stakeholders

  • Current state analysis

  • Ideas raised in interviews

  • Internal team ideation sessions

  • Value analysis

  • Solution value / feasibility analysis

Ideation workshop

As a team, we then evaluated and prioritised each solutions based on desirability, viability & feasibility.

Idea Prioritisation

Not just a digital solution

ART
Forums

Routine workshops for screening actions embedded into risk management procedure

Routine workshops for screening actions embedded into risk management procedure

Risk Thinking
Framework

A learning framework to build a common language & develop consistency in risk thinking

A learning framework to build a common language & develop consistency in risk thinking

Risk Thinking
Champions

Risk Thinking Champions to promote risk thinking and support the cultural change

Risk Thinking Champions to promote risk thinking and support the cultural change

Sentient
(Web App)

A digital solution to guide the Risk Thinking approach, record decisions & automate action closure

A digital solution to guide the Risk Thinking approach, record decisions & automate action closure

Future State User Journey

Future State Map

Low-Mid Fidelity

Initial user testing involved low-fi sketches & card sorting to validate user mental models to inform application workflows & information hierarchy.

I had built strong relationships with my users, so often I would send them a Mural link with a bunch of screen shots and get them to add feedback. This allowed for an asynchronous working style, which suited the users that were time poor.

"This is world leading in the industry as far as I know"

- Ops Manager

Wireframe sketches

Mid-fi UI review and card-sorting activity, results of card sorting

Information Hierarchy

To gain a deeper understanding of how to display information, I conducted a card sorting activity along with A/B testing & a survey.

Card sorting Exercise

Information hierarchy survey

Re-imagining the risk bow-tie

The bow-tie was designed as a logical & consistent way to represent a risk.

This feature was highly valued by junior engineers, as it gave them a clear & methodical way to document the controls.

"This makes more sense than the way it was taught to us."

- Graduate Process Engineer

Senior engineers took a little more convincing.

Each of them had slightly different ways that they were used to documenting risk.

We decided to implement an "MVP" version of the bow-tie first, to give us the opportunity to test it, but not spend too much development effort.

It got a lot of push back at first but, in the end, the bow-tie became loved by many & it was a feature that would be sticking around.

Bow-tie inspiration

Sketches

Final Design

Wireframes stuck on a whiteboard for feedback from team & users.
(These were kept there semi-permanently & routinely updated)

Wireframes stuck on a whiteboard for feedback from team & users.
These were kept there semi-permanently & routinely updated.

Delivery

MVP

Once we had a solid understanding of the solution, I mapped out all the features in a Mural board. After discussing priorities with my team based on our research, I validated them with key users.

This artefact allowed us to ruthlessly hone in on the essentials for our MVP release, with the goal of getting something into users’ hands as quickly as possible.

Story Mapping template

Wizard of Oz Experiment

Before the MVP, we tested our product concept with an Excel spreadsheet POC, replicating the app’s flow during real Applied Risk Thinking forums and manually managing actions in Jira. While seamless for users, our team worked behind the scenes to keep everything running smoothly.

In one workshop, we used a Figma prototype, with our SME scribing in edit mode while others viewed in prototype mode, simulating a fully functioning app & gathering authentic user feedback.

Excel Proof of Concept

Outcomes

How did we define success?

Efficiency

Efficiency

Efficiency

Efficiency

Repeatability

Repeatability

Repeatability

Repeatability

Decision Confidence

Decision Confidence

Decision Confidence

Decision Confidence

Decision Ownership

Decision Ownership

Decision Ownership

Decision Ownership

Psychological Safety

Psychological Safety

Psychological Safety

Psychological Safety

To measure success we…

  • Attended forums to observe decision-making & app use

  • Conducted surveys

  • Analysed system data such as time in action status and action outcomes

  • Conducted time-savings calculations

  • Interviews and feedback loops from users / champions

Welcome to the Risk Thinking Club…

Just 3 months after releasing the first version of our application, we were able to prevent over $2.6 million dollars from being spent on over 76 ineffective risk management actions.

On top of tangible business benefits, we noticed a drastic shift in language, attitude & confidence in decision making.

Although a major improvement, cultural changes take time so we built in a quarterly routine to review progress.

Merch I created for team morale!

An Applied Risk Thinking Forum in action (Left: site-based engineers; right: Perth-based engineers)

An Applied Risk Thinking Forum in action (Top: site-based engineers; Bottom: Perth-based engineers)

An Applied Risk Thinking Forum in action (Top: site-based engineers; Bottom: Perth-based engineers)