Comments on: Above reproach?

By: Chris

Chris — Wed, 06 Jan 2010 21:34:16 +0000

In many professions, part of learning and career development includes constant peer and self-critique. Even in these fields, it’s hard not to take or deliver the criticism personally, and everybody involved needs to realize why there is a culture of critique: to improve both individual and institutional practices. This is especially important in environments where making a mistake can end a life or career. Even second-guessing another’s decision-making raises valid issues, even if they weren’t ultimately relevant.

By: Alex Kovnat

Alex Kovnat — Wed, 06 Jan 2010 19:24:39 +0000

The last two issues of Vertical magazine (The Pulse of the Helicopter Industry), had articles on “the stupid things we do”, including the “watch this” syndrome, taking off without doing a thorough preflight inspection, and so on. Some of the stupid things mentioned, are applicable to fixed as well as rotary wing aircraft.

By: Brendan Fitzpatrick

Brendan Fitzpatrick — Tue, 05 Jan 2010 16:39:19 +0000

Good thoughts – one can’t make all the mistakes so best to learn from those that do. Thanks for this blog – keep it up and Happy 2010!

By: Avi Weiss

Avi Weiss — Tue, 05 Jan 2010 02:45:28 +0000

Tim;

I re-read your original “gross weight” post, and I must have missed the “finger pointing” element that Harold detected. While the analysis is somewhat “anecdotal” in nature relative to actual details, as I pointed out in the comments in the original post, the point being made about the “casual nature” many pilot bring to the weight and balance exercise is spot-on.

I would concur that there is little value in “blame assessment” from a pilot’s perspective, and best left to FAA enforcement personnel and perhaps those partaking in the tort process. But I ALSO believe that it is incumbent on every pilot who wishes to be the best pilot they can be to thoroughly analyze the actions of other pilots “practicing the art of aviation”, especially if those actions result in flights that come to grief. In those cases, careful review of the all the elements of the accident “chain” is not only prudent but an important aspect of the continual learning process all pilots should be actively engaged in.

Reviewing and “critiquing” other pilot action not only brings insight to the operational details at issue, but also the “human factors” elements such as decision making, which are sometimes easier to observe in others actions, rather than our own. ALL “practice-based” professions (lawyers, doctors, etc) have a aspect of “professional conduct review” which looks to objectively review the facts of a particular situation, and work to understand all the salient facts, so that everyone can learn from the situation. Aviation should be no different, although we unfortunately are not allowed to “self police”, and have an outside agency watching over our shoulder. However, that should not stop those of us who strive to be the best we can be, to continue to write blog posts reviewing accident information, and to comment on those blogs to generate the “give and take” that helps us all move forward.

By: Keith Blair

Keith Blair — Fri, 01 Jan 2010 01:12:01 +0000

Tim, I agree with Jon and Tom. The NTSB accident reports are valuable learning tools that can help save the lives of others if used as a proper discussion mechanism. It would be a disservice to those who lost their lives while flying to not talk about an accident and learn from their mistakes. As a Coast Guard pilot, one of the things I love about the organizational culture is our candidness about personal error in aviation. Our mishap reporting system informs the fleet when there is anything from a minor lessons-learned incident to a major mishap. In most wardrooms, we have periodic pilot meetings where pilots will talk about their own mistakes or other lessons so that others can learn. As a matter of fact, my unit recently reviewed a mishap report that just came out about an accident that claimed 4 lives last year. Many in the audience were personal friends with the crew, but we used that mishap as grounds for a frank discussion on in flight emergencies. As was mentioned, it’s often a fine line between pointing fingers and trying to learn what could prevent a similar act in the future. Any discussion should be carried out with the respect anyone of us would want.

By: Tom Hurley

Tom Hurley — Thu, 31 Dec 2009 02:43:38 +0000

I believe we all as pilots, dissect each accident we hear of and usually come to the same decision when warranted….. What was the pilot thinking? I’m sure no pilot intentionally drops from the sky by doing something that they know is not a prudent move. Its more than trying to fly anothers aircraft or second guessing the pilots actions. Reminding pilots sometimes our decision making may not be what it should be is as important as a following the checklist before each flight. I thank aviation writers like you for opening our eyes to the accidents of others. I’d rather be judged by pilots than by ground pounders.

By: Jon S

Jon S — Thu, 31 Dec 2009 01:36:46 +0000

Tim, you’re absolutely right–studying the causal factors in accident, incidents, and close calls is the best way for us to prevent recurrences of those stories. As it has been said, if we don’t learn from the past, we are destined to repeat it.

When we’re picking the events apart, it is hard not to sound like we’re pointing fingers, and that’s probably why the NTSB avoids getting too much into the human factors in their reports. Unfortunately, as we know, human factors are THE biggest factor in accidents. We need to try to understand not just what happened, but why accident pilots made the decisions they made. So, we need to keep talking about the mistakes we all make–especially those that end the worst–and applying CRM, we focus on what is wrong, not who is wrong.

Keep up the great work, Tim.