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When are Company SOP's Dangerous?

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When are Company SOP's Dangerous?

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Old 4th Dec 2006, 18:30
  #21 (permalink)  
 
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Since when was it about winning?
You're quite right SR-71, Good training has nothing to do with winning or losing, that was a poor choice of words.
and asked the non-handling pilot for the “Autopilot disconnect checklist”
But smart comments have little benefit in the sim when we are all working towards the same goal. Just bad CRM.(Now there's another topic!!)
The only QRH's I am familiar with are Boeing's and you can't go far wrong following the Recall/QRH items as laid down by them. Granted, some extreme scenarios (the sort only a cunning Sim instructor can dream of) will require some thinking "out of the box" and require airmanship (or CRM if you will). But as a rule, if it isn't a recall drill, then don't do it from memory, do it from the checklist because under stress even the simplest drill can go wrong.
Going back to the original topic, SOP's, poor SOP's can be extremely dangerous. The amount of writing in the manuals does tend to increase proportionally with the size of company. The better ones are sometimes found in small companies where everyone knows everyone else and is certain of the high standards within the workforce. As the pilot complement increases the range of abilities increases and SOP's grow. The less is written down, the more flexibility it gives crews to use their judgement but it doesn't work in a large company and sadly everyone is looking to cover their backs for the odd occasion when it goes wrong.
At the end of the day, if you find that you are working around an SOP rather than working to it, it often means the SOP isn't right and needs to be changed. A responsible training department is meant to protect line pilots from that sort of occasion.
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Old 4th Dec 2006, 19:01
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Think we are starting to get a little away from the orignal topic 'Are SOPs becoming over complicated as an ass covering excercise by management ?' and not 'Should I deviate from SOPs ?' as this thread seem to be going towards.
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Old 4th Dec 2006, 19:42
  #23 (permalink)  
 
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When are Company SOP's Dangerous?

It must be remembered that SOPs are factored to the lowest common aircrew denominator.

SOPs are essential but also have limitations & can be dangerous to the unwary.
SOPs cannot cater to every situation.

Just maybe, the outcome of the tragic Swissair Halifax accident would have been avoided had the crew concentrated on basic airmanship rather than blindly following the SOPs.
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Old 4th Dec 2006, 21:33
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As a starting point SOPs/Checklists set down by the manufacturer should be adhered to; this if nothing else gives legal protection. The problem starts when these are added to or changed by various fleet managers without reference to the manufacturer or other operators. Boeing instructor pilots are continually amazed how different airlines can fly standard Boeing products in completely different ways.

On a lighter note, I have a theory that changes are only made to standard procedures as the result of a stuff up by a management pilot!
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Old 4th Dec 2006, 23:20
  #25 (permalink)  
 
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MACH 84 is quite right

SOP's are a requirement for a common place to start the flying process. How else can a brand new f/o and a seasoned captain monitor each other's performance on the first flight together, down to mins?

IF your company SOP's are rotten, then report the problem. It is very nice to also include a solution.

My company has a very interesting callout SOP during an ILS approach

1000' (above the airport)

500' (above the airport)

100' (above minimums)

"minimums"


nice huh?


except at a couple of airports where the minimums are 1100' above the airport!

100 above
minimums


1000'

500'



so, I said, how about referencying all calls ABOVE PUBLISHED MINIMUMS?

management couldn't understand


you all be careful out there!

jon
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Old 5th Dec 2006, 02:35
  #26 (permalink)  
 
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J. Seagull, you refer to “smart comments” in relation to the Autopilot disconnect checklist. I am to infer from this that you are unfamiliar with the Autopilot disconnect checklist? You will find it in the autoflight section of the 737 QRH. It is an example of a case where departure from the SOP of only recall items to be done by recall is indicated by common sense. In fact to do as the SOPs dictate in the case I described would be illogical to the point of stupidity. I find it amusing that my exact adherence to the instructor’s instructions are described as a smart comment even though it did demonstrate the above point.

Errors or at least grey areas in the Boeing manuals are mercifully rare but when airline operations management start inventing things then errors, ambiguities and conflictions can really start having an effect. The answer of course is to know the books inside out rather than to ignore them. When these anomalies are found then they must be corrected, good luck by-the-way with getting the experts to even consider a change. You must be aware that there may be a time when you will be required to do the right thing and you have been trained to do just the wrong thing. I heard an instructor telling a group of pilots once that the correct recovery from a jet upset involved rolling completely inverted and pulling through. We’re only human, even the trainers. We all make mistakes. But the loss of life that would have resulted from a pilot following that instructor’s advice would have been appalling.

Mr. Seagull, keep on aviating, keep on navigating and remember that part of communication is listening.
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Old 5th Dec 2006, 06:59
  #27 (permalink)  
 
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The reason for SOP's are to provide guidelines toward safe and efficient operations in such a way that all pilots know what is happening etc..
Obviously therte is no SOP that should you stop from doing your basic duty, namely flying!
too often the management create SOP's that are aimed efficiency and that kind of forget the fact that the pilot has some knowledge, skill, experience and intelligence which would allow him/her to make a safe and efficent operation. eg. release of cabin crew as soon as flaps are set to zero (I think we should obviously consider Wx as well, to say the least)

In my opinion the SOP's should be made (suggested) by all operating crew. SOP's the the ultimate way of sharing experience and thus preventing re-occurrence of certain F'up's. Finaly we should not mistate those little rules that we as individuals use to stay in the loop, those are not SOP's and should not be tought as such (too ofter instructors seem to do so)

Lets suggest to our management to open up the doors for positive discussion regarding the SOP's but stick with them until they are changed.

Nick
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Old 5th Dec 2006, 07:16
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management to open up the doors??

for a positive discussion???

hah. i haven't heard such a contradiction of terms and ideas in a long time!

i also love it when the other pilot is so adamant about the callouts, that he/she walks all over an ATC transmission to OUR aircraft!!! if they would just pause and, then make the call out, it would be a lot safer. waiting a few seconds before the passing 10,000 or BKY active, a thousand to go, or even flaps 1....

it all stems from the "religious" instructions from the training captains and checkairmen.

and it is so funny to hear that those same checkers and trainers are pretty much "normal" when they are not checking or training.

but they don't have the integrity to "see through" those margins when giving checkrides to other captains.
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Old 5th Dec 2006, 09:25
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Some folk are so dead set on getting every call out spot-on and every tiny bit of the day TOTALLY standard, that they have little spare capacity for absorbing what's going on around them.

Also there are some poor dolts who'd be bloody lost without the company teling them when to put the wheels down or pop some flap.

They are STANDARD op's. Should be varied to take account of NON-STANDARD conditions.

Also 'SOP's' IMHO should not be used to 'Dumb down' the operation to the point where fuel and time and money are wasted, simply so the weakest pilot in the company call still pass muster!
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Old 5th Dec 2006, 10:03
  #30 (permalink)  
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Some interesting discussion points have been raised for which I thank you all
SOP's are obviously necessary in our increasing complicated environment,but where should the line be drawn? Covering the arse of management,who are so fearful of crew errors causing an accident that ever more complicated SOP's are drawn up turning us all into robots. The ever present danger of this policy is to reduce a crews situational awareness to such an extent that an incident becomes more not less likely.Deviating from manufacturers SOP's should be only done with great care and caution and constantly be reviewed as to the effecacy of such changes. If the principle of management is to enable blame to be distributed in the event of an incident that that is clearly the wrong avenue to go down. SOP's should be used for one reason only.
TO PREVENT AN INCIDENT HAPPENING IN THE FIRST PLACE. Where they are used as an arse covering procedure by airlines then they are very likely to be barstadised to such an extent as to potentially cause the very incident that they are designed to avoid.
Keep the posts going fellow professionals, your differing opinions are very useful
SA
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Old 5th Dec 2006, 12:43
  #31 (permalink)  
 
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I like SOP's , let me make that clear, I think they are a fantastic thing that make my day a lot easier when flying with someone I don't know.
Unfortunately, a lot of our SOP's seem to have very little to do with a good safe, efficient common sense operation of the aeroplane and rather more with "management stress control".
I personally haven't "been there , done that" or a wealth of experience but I find myself alarmed at what seems to be ever increasing dependency on SOP ( and also on automatics for that matter, but dont get me started!) , by what is supposed to be a community of highly professional people trained to think and act on what they feel is the best course of action.
Yes, in 99% of events SOP's do fine , but I can't help but wonder why managers everywhere seem to think that the other 1% either won't happen because of SOP, or that we'll somehow -even though we're never allowed to do it-, still be able to deviate from rote obedience to the well oiled thinking machine with real handflying skills that was the pilot of yesteryear...
As ever I'll end by saying I am probably talking utter nonsense so just don't waste to many words on my post if U vigorously disagree
Cheerio
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Old 5th Dec 2006, 14:15
  #32 (permalink)  
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I must say that i find this thread a bit worrying. I fly in a medium size company where everybody knows everybody, and often on so intimite details that you can't tell about it to your wife when home
We do have SOP's to cover for most cases, (flyingwise that is) but the company in general have the attitude that there must be room for the individuals. This have done so that half the workforce now develops their own SOP's, with the same excuse as used by a lot of people in this thread: "you can only cover 99% with SOP's. If you don't deviate in the last 1 % it will get dangerous".

What a load of crap guys!!!

I agree about the 1%, that when the **** hits the fan and the SOP's no longer cover, then fly the bloody thing and save the lives onboard, do what is required and get the thing on the ground asap. - I will never question the deviation from SOP when it is NEEDED in the interest of SAFETY. - That is even required by law.

I just find it amazing - as said by another before - that so many tries to intervent flying all over again. How many times are you guys in situations in daily flying where it is nessesarry to deviate due to safety of the a/c? And when you do, is that not actually covered by most SOP's anyway?When everybody starts to deviate because "we are trained to think and act as pilots, and we know much better than the procedures, - and, - sadly that someone sticks to SOP's just to cover their arses", then everybody is working away from each other and who knows whereabout you are and what you are doing??

I am not religious with the books at all, but i often fly into very difficult places in bad wx, and it is just a nightmare with a Captain that knows much better than the books. Experience is good, and mixed with good airmanship and crm I will claim that 999 out of 1000 flights can be done safely without having to be the new Chuck Yeager as so many seems to try and be. And if the company want to be configured in 1000' above, then what is the problem?? - I really dont see it. We also have a term with us stating " non-standard...bla bla bla " and that is still within the SOP's if it is used in the correct manner. So that gives room for different scenarios with busy approaches ect ect. They pay you to do a job and you accepted that when you signed the contract.

We are robots guys. If you want to FLY, then join the military or by yourself a biplane, because now when in the civil world with 200 paying pax in the back, then it is not about having fun enroute. It is about being a busdriver bringing self loading freight from A to B in the safest possible manner. THAT is what you get paid to do.
As I see it, then yes, break every SOP written in any books if that is what is required to come down in one piece. But if you became pilots to have freedom and manouvrespace as individuals, then you are 30 years too late into this business. May i suggest to convert to become building contractors then. They can intervent new methods as they go along , - not pilots


And Now I will have a massive attack for this post from 200 new testpilots



"climb higher, we can almost make it"
 
Old 6th Dec 2006, 02:00
  #33 (permalink)  
 
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No attack from me, you've just missed the point. The discussion is not about whether or not SOPs are a good idea, the original question asked (to paraphrase) are modern SOPs helping safety?

Let me ask a question of my own: If SOPs change (which they do frequently) then surely we can agree that the out-going SOPs were imperfect. If they were imperfect and those before the last iteration were imperfect then can we really believe that the current ones are perfect? What are we to think when the next update is published?

SOPs and the manuals that contain them are constantly evolving entities. 99% of the time they are the result of a genuine effort made by flight ops departments to increase safety and efficiency. In other rare instances they have a certain amount of personal ego behind them. Either way mistakes can occur. Are we all familiar with an accident which happened in the midlands in the 80s? A new aircraft type and new SOPs from a new management pilot keen to assert his authority. This new SOP stated that thanks to the new EFIS flight deck the pilots knew all they needed to know about the aircraft and the flight deck door should remain closed. Any communication through the flight deck door would only serve as a distraction to the pilots from the task of flying the aircraft. The CAA asked the company to change this SOP and described a scenario where everyone on board would know which engine had failed except the flight deck crew. The company refused to change the SOP. The CAA then directed them to change the SOP on pain of AOC revocation. During the period between this direction and the next manual update the exact scenario occurred. This SOP contributed to the death of 47 people. I think that is rather pertinent to the original question.

The last contributor seemed to think that those who don’t follow the SOPs consider themselves as “the new Chuck Yeager”. I do know the type to whom he refers but writing off all those who recognise a ropey SOP as Yeager impersonators does rather miss the point. He and others have said that operating transport category aircraft is boring. I’d like to say that that’s just how I like it but in fact I don’t find it boring at all. Standard operations are key to good crew coordination which is in turn key to safety. However when a flawed SOP creeps into the manual then blind adherence is wrong. If the autopilot trips off then fly the plane don’t grab the checklist. If you’re not sure which engine’s quit then ask those who can see it no matter what some manager once said.

Kirk out……….
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Old 6th Dec 2006, 08:22
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Wish the correspondents, who have posted after me, would read my post
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Old 6th Dec 2006, 19:38
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What is an SOP?

Just to clear a point, there is a check list, then there is the standard operating procedure (SOP).

Companies are allowed to alter the manufacturers' checklist, provided all the points are safely covered. Mostly they stick to it.

The SOP is what happens outside the checklist and varies greatly from company to company. Now and then a (non checklist/QRH item) bad situation arises which makes the flight managers think hard and put a new item in the SOP. Unfortunately the reasoning for this gets forgotten over the years and other operators either don't have it or have dealt with it a different way.

After a time the SOP gets unwieldy and unpracticable.

I think this is a very good thread, having been in the position of writing SOPs myself and suggest that an operators' SOP meeting should take place to rake over these items and boil them down to a mininum. The manufacturer should also be involved in this process.

FC.
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Old 6th Dec 2006, 22:14
  #36 (permalink)  
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Originally Posted by James T. Kirk

The last contributor seemed to think that those who don’t follow the SOPs consider themselves as “the new Chuck Yeager”.
Kirk out……….
The correction regarding me turning the subject is taken, and I admit that i got carried away by reading some of the previous postings.
However, - just to clarify, then i did not state that those who do not follow SOP's are all Chuck Y'gers, I was more referring to some of the previous comments here from people whom sounds like SOP's are the worst thing around.

4Green: I did read your post but don't know what to say to it??

Have a nice weekend all
 
Old 7th Dec 2006, 01:19
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Saddest,
Twice now you've mentioned following manufacturer's SOPs as being the safest policy. Having written or contributed on a number of AFMs, SOPs, FCTMs, QRHs and tinkering a bit with MELs for 3 major manufacturer's and for 1 large legacy carrier on at least 4 different types (Douglas Beoing, Airbus and Bombardier) I would be very careful with offering such advice.

The truth is that they're often full of errors and despite all the checks and balances some doozies do actually end up in the lap of crews. Believe me - absolutely nothing out there from the manufacturer's is gospel. It depends on the manufacturer but generally the AFM and the FCTM are probably the most reliable (error free) sources of operating info but neither, on their own, or in unison, can assemble a good SOP for practical real time scheduled commercial carrier operations. I think if you reviewed the opening comments in any AOM or FCOM SOP section you'll find that unlike in an AFM, the procedures given there are only recommended and further to that point I might add, in no way absolve the carrier from liabilty in the event of a accident.

That brings me back to your original question.

when does blind adherence to sops in itself ( if those sops are complicated ) become a serious flight safety hazard?
I think most would agree it's when airmanship is taken out of the equation.

Why some carriers go beyond that and micro manage them is beyond my own personal experience. Perhaps it's the variety of equipment, the mod status of each aircraft, operational neccessity, sometimes the inspectors/regulators are a little too by the book or anal, etc, - there's a myriad of reasons.

Perhaps also it's the nature of the crews and a function of their average training or experience related to the carrier itself . I could see where that might lead to a bit too much info in the SOPs and take some control out of the crews hands. In some cases it just might be well warranted though. The example that springs to mind is a retired colleague on a training contract on 744s for a bunch of folks who rode bicycles to work. Perhaps he was exaggerating bet their adventures (mis?) are well documented here on PPRUNE.

My last point is that SOPs are not static. They continuously evolve and strive to maintain a balance of too much info vs not enough for all of the crews. In a larger carrier the level of airmanship above a certain minimum ability varies quite a bit. Not everybody is ex USN or RAF or has 10 yrs on type in the left seat. Good for you if you're above the curve but you have to recognize that the newly transitioned F/O is just of his/her check ride and has limited line experience on type. You need for for him/her to maintain situational awareness and understand what you're doing. For that case an expanded SOP is one of his/her primary training tools.

In the end safety and avoiding liabilty is best achieved by balancing experience and knowledge against accepted practice and training. Airmanship and SOPs. Neither is foolproof and covers everything but in unison, getting the balance right goes a long way to making sure there aren't any headlines and board hearings.

Last edited by nnc0; 7th Dec 2006 at 03:40. Reason: Grammar and spelling weren't my strongest subjects in school.
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Old 7th Dec 2006, 01:40
  #38 (permalink)  
 
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Originally Posted by 4Greens
As a starting point SOPs/Checklists set down by the manufacturer should be adhered to; this if nothing else gives legal protection. The problem starts when these are added to or changed by various fleet managers without reference to the manufacturer or other operators. Boeing instructor pilots are continually amazed how different airlines can fly standard Boeing products in completely different ways.
On a lighter note, I have a theory that changes are only made to standard procedures as the result of a stuff up by a management pilot!
Please read my last post. Manufacturer's do make mistakes. Operator diligence in proof reading anything before general distribution to line crews is always required. I won't identify specific examples but think in terms of how documentation is produced and the process. The ACME aircraft chief pilot isn't sitting in a back room writing out procedures that make their way directly to you. He will obiously have input but so do the engineers, the systems folks, the e-docs people with their databases etc and other assorted groups. There's always a weakest link in there and a bunch of meddling and in the end you may someday find yourself using a relight or tailpipe fire procedure on your PW engine(s) ultimately put together by somebody who was sure you had GE's. You'll also find the number of manufacturer errors increases drastically following mergers or when getting aircraft on the used market when equipment specs might not be quite correct or up to date.

I won't say which manufacturer makes the least errors but I do think The Boeing folks probably do the best job I've seen in achieving consistent policies across the different carriers. That's not to say they're any better at writing error free SOPs but in my experience they work with carriers much more effectively and they're much more hands on. Better and more consistent customer service I suppose you could call it. Then again, maybe their brand of customer service just worked better with our people and our way of doing business. I should add that I don't have half as much experience working with Airbus people but I do respect their expertise and support efforts. In a few more yrs I might even change my mind.

As for the different ways they're (Boeing) amazed, they've taken steps to lessen that. When I left they we had just finished some QRH focus group work and it was amazing the way different languages interpreted the same sentence in English. As a simple unilingual type, it was quite an eye opener and a real shock to see the different interpretations in some rather sensitive situations of something I thought was quite straightforward and clear. Although I haven't seen it implemented in practice the push at that time was to introduce standardized symbology/icons and phrasing along with a fault tree process flow into the QRH. I'm not sure how far they got with it though but in re-reading Saddest's original post I suspect some of that is working it's way into the system.

As for management pilot mistakes leading to SOP changes - Think lowest common denominator and then factor in monthly duty times.

Last edited by nnc0; 7th Dec 2006 at 05:05.
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Old 7th Dec 2006, 19:59
  #39 (permalink)  
 
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How-bout we factor in 400+ pax, 1 billion $ of risk, the companies reputation, and ....... some terrain.

It's the Companies prerogative to have their aircraft operated in a conservative manner..... we are paid to do that. I am yet to see an SOP that advocates risk taking (no tall stories please).

If you want a bit more freedom "buy" your own aircraft

Last edited by slamer.; 8th Dec 2006 at 20:49.
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Old 8th Dec 2006, 16:00
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THeres good flying and bad flying.Aviation survived for many years before the introduction of CRM and SOP's.Good flyers might break SOP's or infringe the tenets of CRM when required but they're still good.Bad flyers might never break SOP's and be everyone's buddy-buddy but they're still bad.
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