In my youth I worked for British Aerospace. As a junior pilot I recall on a ‘Black Flag’ day sitting in the crew room when an old hand came out with a saying which has stuck with me ever since...
IF YOU THINK TRAINING IS EXPENSIVE WAIT UNTIL YOU ARE AN ACCIDENT
In this particular case, the Swiss Cheese model springs to mind. You do wonder just what CRM training took place, and just how robust the whole process was......
They need to engage with an independent EASA CRM provider(s) who will look at the whole organisation root and branch. National cultures are of course the basic ingredients which need to be moulded into a safe secure organisation.
Even now it is difficult to understand how the crew fell into this trap given previous well publicised worldwide events....I know it is easy to sit in an armchair and pontificate......however comma this is a fundamental gross error given that no evidence has yet to emerge of aircraft unserviceable items.