11 SAC Pitch Organizational Silence...A Story for the Safety Awareness Campaign (with colorful and...
Transcript of 11 SAC Pitch Organizational Silence...A Story for the Safety Awareness Campaign (with colorful and...
Organiza(onalSilence
AStoryfortheSafetyAwarenessCampaign(withcolorfulandexci(ngillustra(ons)
NormalSilence
Organiza(onalSilence
Itisunwisetoleavealivedragonoutofyourcalcula.ons,ifyoulivenearhim.‐‐JRRTolkien(TheHobbit)
NASAlivesnearthedragons• Mission‐ProjectDriven• Largebutcloseknitorganiza(onwithpowerfulleaders
• Highlyvisible,complexprojectswithschedulewithbudgetpressure
• Teamenvironmentwheretheteamischargedwithachievingsuccess• And……thereareACTUALpeopleinvolved
Thesecondi(onsarethebreedinggroundfortheDragon
Introduc(ontoaDragonWaterInges(onProjects
• DemonstrateimmunityofnewaircraNdesignstoinges(onofstandingwaterattakeoff/landingspeeds.
AnatomyofaDragon
• Needed:– 1ModifiedaircraN
• Withtestpilot– Aflat,lowtrafficrunway– ControltowerwithOpsLead– Cameraswithagoodviewoftheairintakes– 2weeks(accoun(ngforweather,technicalglitches)
• Process– PlacewateronrunwayatFAA‐specifieddepths– AircraNrollsthroughattakeoff/landingspeed– Snappictureofengineairintake
LOOKINGCAMERAS(C2&C2)EQUIPMENTVANS(V2);DistanceFromRunway:~200N#Personnel:3
C1C2
CFR
IFLOT(C1)EQUIPMENTVAN(V1)DistanceFromRunway;~200N#Personnel:2
CFR/FAAWATERTANKERDistanceFromRunway;~200N#Personnel:5
RADARGUNANDOPERATOR(V3);DistanceFromRunway:~200N#Personnel:1
V1
V2T1
Opera.onsPlan
TheDragonGrows• Opera(onReviewedandApproved
– Opera(oniscompletelyencompassedbypastexperience• AircraNsizes,speeds,technicalrequirements
– ThenormalANDEXPECTEDproceduresandsafetymeasuresareinplace
– LessonsLearnedfrompastmissionsincorporatedintoopera(onsplans• Visualcues,instrumentplacement,wind/speedlimits,CrashFireRescuestaging,cameraselec(on
• Experiencedteam• Opera(onsproceedswellthroughmul(ple
runs• Minorrequirementschangeswitheachrun
aNerday1– Reviewedandapprovedbyteamandcustomer
LOOKINGCAMERAS(C2&C2)EQUIPMENTVANS(V2);DistanceFromRunway:~75N#Personnel:3
C1
C2
C3
CFR
IFLOT(C1)EQUIPMENTVAN(V1)DistanceFromRunway;~200N#Personnel:2
CFR/FAAWATERTANKERDistanceFromRunway;~200N#Personnel:5
RADARGUNANDOPERATOR(V3);DistanceFromRunway:~75N#Personnel:1
V1
V2V3
T1
MissionOpera.onsatLastRun(Run11)(Implementa.onaWeriteratedsmallchanges)
LOOKINGCAMERAS(C2&C2)EQUIPMENTVANS(V2);DistanceFromRunway:~200N#Personnel:3
C1C2
CFR
IFLOT(C1)EQUIPMENTVAN(V1)DistanceFromRunway;~200N#Personnel:2
CFR/FAAWATERTANKERDistanceFromRunway;~200N#Personnel:5
RADARGUNANDOPERATOR(V3);DistanceFromRunway:~200N#Personnel:1
V1
V2T1
OriginalOpera.onsPlanforComparison
WhattheDragonlookslikewhenitisfinallyafacking
ElementsofandThoughtson
Organiza(onalSilence,Dragons,andDragonSlaying
Welosesomedexterity,butweareveryconfident
Today’sCrisis
Let’sneverforgetthatthepublic’sdesirefortransparencymustbebalancedagainstourneedforautonomy.
Ithoughthewasabouttobeknighted,didn’tyou?
You will make the same foolish mistakes you have made before, not only once but many many times again
Management
Engineering
Opera.ons
ShamelessappealtoanOscarwinningfilm
What“EVERYONE”Knows
• Whatalmosthurtsomeonelast(me.
• Howfaristoofar,ortoomuch,ortoolong,ortoohard…andhowclosewearetotheedge.
• Whichorganiza(ons/peopledon’tgetalongANDhowthatstressimpactscommunica(on.
• HowthingsREALLYhappenandwhich“rules”don’tgetfollowed.• What‘really’wentwrong
• Whatalmostwentwrongandwho‘really’savedtheday.
• That“LL”doesn’tstandfor‘lessonslearned’.Itreallyjustmeans‘lessonslisted’un(lsomethingisdone.
• Whatplaceswillnevergetseenduringtheinspec(on‐‐‐becausetheywouldneverpassit.
• Thatthechecklistdoesn’treallymaferasmuchasthepersoncheckingtheboxes.
• Thatorganiza(onsdon’tfixproblems…peoplefixproblems.
• Whichmanageryoucantalktowhensomethingiswrong….andwhichoneyoucan’t.
Itreallyistruethat“everyoneknows”…..
Maybe,YOUknow….
Theques(onis,
Whatareyougoingtodoaboutit?
Youronlyweaponisawillingnesstocommunicate.
Youhaveasword.Itisseemssmall,butit’sallyouhave.….it’sallWEhave.