Thursday, April 22, 2010

Classroom in the Sky

The opening of much of the European airspace in the last several days has provided a rare opportunity to observe in real time some dynamics of safety decision making. On the one hand there have been the airlines who have been contending it is safe to resume flights and on the other the regulatory authorities who had been taking a more conservative stance. The question posed in our prior post was to what extent were business pressures influencing the airlines position and to what extent might that pressure, perhaps transmuting into political pressure, influence regulators decisions. Perhaps most importantly, how could one tell?

We have extracted some interesting quotes from recent media reporting of the issue.





Civil aviation officials said their decision to reopen terminals where thousands of weary travelers had camped out was based on science, not on the undeniable pressure put on them by the airlines....’The only priority that we consider is safety. We were trying to assess the safe operating levels for aircraft engines with ash,’ said Eamonn Brennan, chief executive of Irish Aviation Authority. “Pressure to restart flights had been intense.” Despite their protests, the timing of some reopenings seemed dictated by airlines' commercial pressures.

"It's important to realize that we've never experienced in Europe something like this before....We needed the four days of test flights,the empirical data, to put this together and to understand the levels of ash that engines can absorb. Even as airports reopened, a debate swirled about the safety of flying without more extensive analysis of the risks, as it appeared that governments were operating without consistent international guidelines based on solid data. "What's missing is some sort of standard, based on science, that gives an indication of a safe level of volcanic ash..." “Some safety experts said pressure from hard-hit airlines and stranded passengers had prompted regulators to venture into uncharted territory with respect to the ash. In the past, the key was simply to avoid ash plumes.”

How can it be both ways - regulators did not respond to pressure or regulators only acted based on new analysis of data? The answer may lie in our old friend, the theory of normalization of deviation. ref Challenger Launch Decision). As we have discussed in prior posts normalization is a process whereby an organization’s safety standards maybe reinterpreted (to a lower or more accommodating level)over time due to complex interactions of cultural, organizational, regulatory and environmental factors. The fascinating aspects are that this process is not readily apparent to those involved and decisions then made in accordance with the reinterpreted standards are not viewed as deviant or inconsistent with, e.g., “safety is our highest priority”. Thus events which heretofore were viewed as discrepant,no longer are and are thus “normalized”. Aviation authorities believe their decisions are entirely safety-based. Yet to observers outside the organization it very much appears that the bar has been lowered, since what is considered safe today was not yesterday.

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