'A picture paints a thousand words'

Bowtie methodology is a barrier-based and best practice qualitative risk management tool which allows organizations to meet both regulatory and senior management's expectations regarding the management of their operational risks in an easy-to-understand and accessible manner based on a Bowtie diagram.

By visually depicting the manner in which accident scenarios are controlled through barriers and safeguards  (plant, people, processes) the Bowtie diagram and the risk information it contains can be readily understood and accessible by people at all levels of the organization, from senior managers to frontline personnel. 

From now on, instead of struggling in wading through hundred of pages of a HAZID/HAZOP study or a Safety Case/Major Hazard Report, frontline personnel, as well as operational and senior management people will have access to a short, clear and visual overview of the major accident events, how they are controlled by existing controls for which they are responsible/accountable, all of which helps people understand the role they play in major accident prevention and rise awareness of the importance of carrying out safety critical tasks right first time.


BowtieXP methodology and Software

We offer a high quality 3-day training course in the Bowtie risk management methodology and BowTieXP software. The aim of the training course is to prepare people in a wide range of major hazard industry sectors to understand and conduct quality barrier-based risk management processes using Bowtie. These people include - Corporate Risk Management, HSE Advisors, plant managers and engineering and O&M personnel, as well as other people with responsibilities in risk management.

The Course content is delivered by a Consultant who has extensive experience in both delivering Bowtie Training Courses and implementation of Bowtie risk management methodology and software as part of the management system and preparation of Safety Cases/Major Hazard Reports.

The Course contains both theoretical and practical sessions and will cover the following aspects:

  • Bowtie Theory & Bowtie Diagram Construction rules
  • Assessing effectiveness and quality of controls (barriers and safeguards) 
  • Linking with Safety Management System (SMS)
  • ALARP, improvement actions and reporting options (Major Hazard Register)
  • Safety Critical Elements (SCEs) identification and management
  • Human Factors and the Bowtie methodology
  • Planning and building Safety Cases/Major Hazard Reports using Bowtie methodology

If you wish to apply for a Training Course, please fill the Request Form or email us directly at iageenko@todusadvisors.com 

Human Factors

Management of Human Errors and Safety Culture

We analyse and manage human errors by using Human Error Layered Bowties (as recommended by both CCPS and CIEHF) with Bowties at lower levels being developed to give progressively more detailed attention to how human error can defeat barriers, and the safeguards that need to be put in place to mitigate against it.

With the help of our experienced Human Factors Expert we carry out the following activities by involving knowledgeable/responsible from the Client:

1. Prepare Human Error Level 1 draft Bowtie based on: 

  • Information regarding degradation factors (human related) associated with barriers identified in Level 0 Bowtie
  • Results of the talk/walk-through review to identify the Performance Influencing Factors (PIFs) with major impact on those safety critical tasks where  human errors are identified as degradation factors.
  • Preliminary information on existing/additional safeguards to prevent the occurrence of each degradation factor.

2. Review Human Error Level 1 Bowtie with responsible/knowledgeable O&M and supervisory personnel to confirm and agree on PIFs of major significance and existing/additional safeguards to reduce risk to ALARP. 

3. Prepare Human Error Level 2 draft Bowtie based on:

  • Information regarding degradation factors associated with organizational culture identified in Bowtie Level 0 and Level 1.
  • Results of the Safety Culture study at Client's organization, according to 10 distinctive traits.
  • Preliminary information on existing/additional safeguards to prevent the occurrence of each degradation factor associated to organizational culture.

4. Review Human Error Level 2 Bowtie with responsible/knowledgeable O&M and supervisory personnel to confirm and agree on existing/additional controls.

5. Provide a list of improvement actions for the management of human errors and Organizations' safety culture to reduce risk to ALARP levels.

    Bowtie Risk Management 

    Organizations conducting operations and activities in major hazard industry sectors, such as, Oil and Gas exploration and production, Oil Refineries, Nuclear Power Plants, Aviation, Railways, Chemical and Petrochemical, Mining, Finance and Banking, Medical and Pharmaceutical, Medical Services, IT and the like, are expected to manage their operational risks in a manner that ensures a high level of protection to human life, environment, assets and company reputation against the occurrence of major (catastrophic) events​​.

    How Can We Help? 


    Bowtie implementation at Organizations

    When a Company decides to go ahead with Bowties, whether as part of the major hazard risk assessment, implementation of Bowtie into Operational/Asset safety management systems or preparation of Safety Cases/Major Hazard Reports we carry out a Bowtie building and implementation process by facilitating highly interactive Bowtie workshops with the active involvement and participation of the 'knowledgeable' people in the organization as well as other SMEs, for each of the identified Major Accident Hazards (MAHs) and Major Environmental Incidents (MEIs).

    As part of the Bowtie building and implementation process we carry out with the Client's personnel some or all of the following activities:

    • Step 1. Establishment of the framework for Bowtie implementation
    • Step 2. Prepare draft Bowties with Subject Matter Experts (SMEs)
    • Step 3. Review draft Bowtie with key personnel  through facilitated Bowtie Workshops in order to agree on Hazards, Top Events, Consequences, Causes (Threats), Barriers, Degradation Factors and Safeguards for each of the Major Accident Hazards (MAHs)
    • Step 4. Prepare draft Bowtie diagrams with corresponding safety improvement actions.
    • Step 5. Complete the meta data details on the barriers and cross-checking barriers/procedures against what's really in place.
    • Step 6. Identify safety critical tasks for those barriers that rely on human performance or degradation factors associated with human error.
    • Step 7. Carry out Human Error Bowtie Workshops (as indicated in the "Human Factors" heading on the right)
    • Step 8. Validate the outcomes of the Bowties in relation to the quality of the barriers and their capability to reduce risks to ALARP?
    • Step 9. Compile a Major Hazard Bowtie Register.

    If requested, we also help Clients to:

    • Prepare a Register of Safety and Environmental Critical Elements (SECEs) and Safety Critical Tasks (SCTs) which serve as an input to other barrier management schemes (i.e. assurance and verification schemes)
    • Develop a Summary of Operational Boundaries Matrix (SOOB)/Matrix of Permitted Operations (MOPO) which provides a useful guidance to supervisors and managers to decide where to stop operations due to a weakened risk reduction measure and when to apply compensatory controls to supplement such weaknesses.

    'Fit-for-purpose & usable' Safety Cases/Major Hazard Reports 

    Safety Cases/Reports are often produced to ensure regulatory and obtain regulatory approvals. But it is important that the final product - the documented Safety Case/Major Hazard Report are not seen as the final goal. The process of producing the safety case/report is as important as the final product as it must represent a true aid to thinking - "a meaningful exercise reflecting the experience, knowledge and opinions of the frontline, rather than a mere paper based exercise to collect evidence that the system or product is safe. 

    The Bowtie methodology has proved to be an effective tool for supporting the production of fit-for-purpose Safety Cases/Major Hazard Reports which are easily accessible, understood and used by key end users by:

    • Improving understanding, visibility and accessibility of complex Safety Cases/Reports.
    • Facilitating active workforce involvement and Company's ownership of both the process and the final product.
    • Linking fault/risk analysis with the management system to demonstrate system's adequacy.
    • Keeping the Safety Case/Report updated and "out of the shelf'.

    Management of Asset integrity & Human Error

    By closing the gap between risk analysis and Company's management system the Bowtie methodology not only provides assurance that hazards are effectively controlled but it also ensures that the management system is adequately support the ongoing integrity and effectiveness of those hardware barriers commonly known as "Safety Critical Elements (SCEs)". In other words, it provides assurance that they will be in place and continue to be 100% effective at all times.

    Thus. the Bowtie diagrams with reports of supporting critical activities and SCE equipment can act as checklists to verify that the hazards continue to be controlled as intended.

    Human error has long been identified as a contributing factor to incident causation.  The new so called "soft safety era" puts more emphasis on human and organizational factors (HOFs), recognizing that human errors contribute to the almost 80% of accident occurrences, being the organizational and behavioral problems the 70% out of that contribution.

    This reality means moving onto a more comprehensive and deeper consideration of human, organizational and behavioral factors in current analytical tools for major accident prevention, such as Bowtie.