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Old 7th Oct 2004, 03:31
  #53 (permalink)  
Rongotai
 
Join Date: Oct 2000
Location: Wellington
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To try and take up MOR's challenge:

The issue for me is whether the objective of incident investigation is to reduce the frequency of critical incidents (make the industry safer) or determine who was at fault (to identify who to punish or sue). If you lean too far one way you let incompetent performance off the hook. If you lean too far the other way you increase the frequency with which competent people make errors.

It is my view that at present we are generally too far towards the fault finding end of things. A significant consequence of this is that very few people feel safe in putting their hands up when they make a mistake. Thus we:

(a) lose the opportunity to learn from the mistake;

(b) have greater difficulty in distinguishing between the prudent and imprudent pilots (because the imprudent will never put their hands up, no matter what, whereas the prudent will if they know they are going to be treated justly).

I find it very hard to understand why the aviation industry has a problem with this. Selection, training and induction procedures, and line checking are generally superb. If that is so, how can we believe that there are lots of cowboys out there?

If there are a lot of imprudent pilots, then I must be seriously wrong and training and induction is desperately in need of review. If I am right, and if most employed pilots are of high quality, then why is there such an easy willingness to slag off individuals when something goes wrong?

So my current judgement is that there is a cultural problem in the industry (not universally, but in many airlines) that is making it very hard for otherwise competent pilots to discuss their errors in an open way that would allow for continuous improvement in training and operational procedures.
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