Inflight Safety Culture

[Kelvin]

I have the magazine "Flight Safety Autralia" Jan-Feb 01 edition with a feature article on "The Brainy Bunch. Why they will change the way you think about aviation safety" This bunch (Murino, Reason, Helmreich) had been involved in research that involved thousands of air crew recover from threat and error in normal operations. They say that "Making errors is a fact of life, but recovering from them - particularly when these recoveries involve heroic improvisations - is another matter". They presented as key speakers at the 5th Australian Aviation Psychology Symposium at Manly, Sydney in November 2000. I'm interested in abatement systems of human error.

 

 

Did anyone get along to that symposium? Is anyone a member of the Australian Aviation Psychology Association www.vicnet.net.au/~aapvpa/ ?

 

Kelvin (with a long way to go and dont mind learning a thing or two along the way)

 

 

[Guest High Plains Drifter]

when these recoveries involve heroic improvisations

Carnt aswer your questions there Kelvin, but I got to wonder about "heroic improvisations" as an inflight emergency recovery device.

 

When it comes to ultralights I would of thought pilot training would have it covered. No thinking about 'improvisations' required as such.

 

For example; engine fails - you do this...

 

 

[Kelvin]

Carnt aswer your questions there Kelvin, but I got to wonder about "heroic improvisations" as an inflight emergency recovery device. When it comes to ultralights I would of thought pilot training would have it covered. No thinking about 'improvisations' required as such.

 

For example; engine fails - you do this...

Yep, HPD that definately needs clarification. The article relates to a pilot of a Boeing 767 in July 83, looses power at 35000 feet and diverts to a small airstrip at Gimil in Canada. As he approached he could not control speed without flaps and slats. He reverted to a slide-slip technique he learnt as a glider pilot to get it down with 61 passangers. His employers had never imagined the slide slip manoeuvre being applied to a wide-bodied jet airliner. It was an improvisation he had to try in the absents of any other training for a 767 emergency.

On a more general note as it applies to RA, I wonder if there can be circumstances that may arise and do not fit with what we understand from our training, as a precursor to an emergency. I'm thinking about clues that are likely to be missed both on the ground and in the air and how well we understand the extent of training we need to have to mitigate these exposures.

 

Kelvin (with a long way to go, and sharing an inner thought)

 

 

[spacesage]

As pilots we are always taught to err on the side of safety.

 

However, this can sometimes lead you to do things that may not be as safe as other courses of action.

 

The overly cautious pilot can also end up in situations made of thier own behaviour as can the overly agressive pilot.

 

I think that every situation is different and requires a level of common sense or lateral thinking to be applied. I think you will find that most pilots that do this in emergency situations are the ones that "get away with it".

 

 

[Guest High Plains Drifter]

Kelvin, if you havnt already found it, heres an interesting flight instructer -

 

http://www.overtheairwaves.com/

 

Bob Miller has some interesting thoughts about private pilot flight training in the US -

 

There is one sad fact about traditional flight training that we seem to forget. That fact is, approximately 60 percent of all new flight students drop out before obtaining their private pilot certificate. Not surprisingly, they drop out for one or more reasons.

 

High on this list of reasons is that their flight instructor managed to destroy their students' joy of flight during the initial training hours.

 

For example, the new student is taken immediately to the practice area where he engages in mindless and repetitive maneuvering exercises followed by takeoff and landings at the same one or two local airports.

 

Over and over, up and down, up and down, the new student trades the thrill of flying for some inane ritualistic air work called for by a 50 year-old flight training curriculum. Rather than integrating the building blocks of flight training into a meaningful whole, the student quickly grows either bored or frustrated.

 

May 2008 issue

 

I have no experience of ultralight training here in Oz (I was given a pilot cert when it was introduced) but Bob Millers comments cover the Oz private license very well.

 

Like many at the time I originaly tought myself to fly ultralights (later learnt the private) While I dont recomend self teaching, the fact that it can be done makes me wonder about the training system.

 

 

 

When I hear about how long it takes for some pilots to learn I ask is it because of the pilot, the instructer, or the training system?

 

 

 

[Galpin]

I happen to agree with the comments made by Bob. The whole training regime, in my opinion, needs more than an overhaul. It needs a complete restructure.

 

 

[eastmeg2]

HPD, with 3 mile circuit legs that's not suprising. With trikes, (and I suspect high drag UL's like a thruster or X-Air would be the same) crosswind and base legs are merely several hundred metres. Downwind is slightly longer than the airstrip. Where I learned on a 700m strip we were able to achieve 12 circuits per hour. How many circuits per hour can realistically be achieved in a C150?

 

I don't pretend that flying a Thruster/X-Air would be similar to flying a C150 but the basics can be learned and the limiting factor becomes pilot fatique (which the CFI should monitor) rather than boredom.

 

Rgds,

 

Glen

 

 

[vk3auu]

Bob Miller looks like a bloke who knows what he is talking about.

 

David

 

 

[Guest TOSGcentral]

I am in total accord with Bob Miller’s words as relayed by HPD. He is entirely right (as is Galpin’s response also) – but it is not quite as easy to fix as may seem to be the case.

 

 

I speak here from a position where this area has been of consuming interest to me and I became deeply involved in analysis and re-structuring of both basic and instructor training methodology. I developed my own syllabus and training systems over 35 years ago, taught them to many, and had considerable success in so doing.

 

 

So I can assure you all that there are far better and more effective methods of doing things and you do not have to be a naturally gifted instructor to do so – it is something virtually any flight instructor can learn quite quickly if they are taught and orientated efficiently – with a lot of emphasis going into both individual flight exercise as well as overall syllabus management – if you have the system to do so with.

 

 

You can in fact (and that is a main objective of the exercise) give a raw graduate of an instructor’s course the working effect of in-field instructors with several years experience under their belt immediately. This significantly reduces the student wastage while the new instructor self-teaches to get things working in the normal course of events.

 

 

The overall motivation for doing this sort of stuff is certainly to obtain greater flight safety and situational awareness – building the Airman rather than just an aircraft driver (and you get that almost automatically) but primarily to reduce student drop-out. This is not just important for students being able to acceptably meet their own goals but is equally important (maybe vital) for individual schools and entire aviation movements to be successful and have surplus to recycle back into further improvement of standards and facilities.

 

 

Bob Miller was however wrong in one area. He indicates 50 years of syllabus entrenchment. It is in fact 90 years! The recognisable structure of what we primarily do today is founded on flying training as it began to crystallise in 1918. That is one helluva habit pattern to try and shift!

 

 

Now, I am going to speak somewhat bluntly by which to obtain clarity, so will you please give me the courtesy of NOT leaping on my back and accusing me of cooking up yet another ‘Tony Hayes critique of RAAus and how it is run!†That is NOT my intention – either overtly or covertly! But it t will be far easier to example situations that readers can relate to.

 

 

There are a number of factors that have to be considered when approaching revision of training methodology. The following outlines these:

 

 

* Student Motivation. The prime purpose of flying training has to be orientated directly to the purpose that the student wishes to learn to become qualified in. There are a number of these – low/mid level GA, career Commercial, Military & Recreational. The latter splits rapidly into balloons, gyros, gliders (in many forms now including motor gliders), tri axis control ultralights, Weight Shift control, powered parachutes, foot launched. It is rather strange to believe that a centralised flying training syllabus and methodology may be successfully applied to all of these concurrently. If it is and you are trying to fit a square peg into a round hole then all you will be left with are the survivors whose personal motivation is strong enough to get through it.

 

 

• Quality of the student applicant. Nobody is going to waste time training anyone for intensive commercial or military flying. Applicants will be screened first and (in the civil area anyway) be expected to have put their own runs on the board experience wise (flying instructors ‘teaching’ to build hours when their personal motivations are elsewhere?). They will all have to have a high level of education and supreme physical fitness. If they do not comply with the requirement in practice then they will be junked (which stimulates motivation no end to become a cog in the wheel) but does not in the recreational area because the student simply says “stuff it – this is not what I wanted†and so walks out! It does not for the housewife who at last can achieve for herself, or the average Joe who just wants a more cost effective and quicker way of checking his property fences are still up or his watering holes have not broken down, nor the guy getting on a bit in years who can now afford to scratch a long held itch!
   
  

 

 

• Quality of the Flying instructor. This is entirely dependent, not just on personal qualities of an individual, but how those qualities can be drawn out and maximised by the quality of the instructor training and requirement that is imposed by any individual system or control organisation. If any organisation is not correctly orientated to its purpose and the people that it trains, therefore the manner in which they are trained , then there is going to be huge wastage rate and so many broken dreams. This can actually be factually demonstrated.
   
  

 

 

As a Board Member I ran a personal survey using collated membership figures of AUF over a three year period. We went into the period with around 3000 members and came out the other end with a very similar figure yet we had around 2400 new members recorded over that period.

 

 

In simple terms this means that we were losing members as fast as we were getting them to the extent of 800 people a year in a very polarised interest industry. Those are unsustainable figures for any business and AUF/RAAus has to be run on business principles!

 

 

Now certainly there is turn-over of members and I am not suggesting that we lost every new member that we got in because the place was hopeless. There will also be those who found they did not like it, could not afford it, other life issues got in the way etc etc. I do think (that in our case at least) Bob Millers figures at 40% retention rate are on the high side and a great deal of our losses were failure to be able to come to terms with the training system in one way or another. That is something that we may address – but in practical terms can we?

 

 

I put these findings to the Board and to the credit of AUF a Board member was appointed to look into the issue and a good effort was made to do so. But the effort collided with a cliff that is composed of the actual main obstacles in their various forms so no progress was in fact made.

 

 

The situation was then obscured by the quickly following introduction of RAAus that opened the flood gates to a pent-up and dissatisfied lower end of GA. That certainly got us a heap of members and on the surface our movement appeared to be a raving success. But in business terms it is no more than introducing new lines that there is demand for and that demand will eventually level out.

 

 

If in the meantime the selling method (ie training methodology) has not orientated to the actual demand market then we will settle down to what was happening previously but this time at a higher numbers turn-over from a higher level members number base. That is forecastable and should be part of RAAus’ forward financial planning – maybe it is, I do not know!

 

 

What can be clearly seen is that the expansion and therefore influx of new types and both airworthiness and particularly training demands, is rapidly expanding. Some valuable inroads are being made by RAAus particularly in the new divisions in the pilot certificate approval categories – but that puts pressure on a far flung movement to supply that breadth of training and how convienent, practical or even affordable is it to even access that training by any individual member?

 

 

RAAus’ prime responsibility is to ensure that a standard of training is in place. There is a consequent responsibility to ensure that the quality of that training is adequate. There is NO responsibility on the part of RAAus to supply all that lot on any street corner! There probably is a duty to inform existing and intending members where that training may be reliably accessed such that decisions can be made.

 

 

OK – so let us move on a bit and ‘collide with the cliff’ mentioned above!

 

 

So we want to make everything (in at least basic training terms and by consequence instructor training terms) all sweet and rosy – totally orientated to our membership needs and creating a believable and effective ‘Safety Culture’? This is the sequence:

 

 

• First and foremost there has to be recognition of the training needs of the establishment and what it’s members actually want. There has to be acceptance of the student applicant level allowed such that the training may be achieved and this must be pitched at the lowest common denominator of student able to receive the minimum qualification. None of that is likely to happen in a recreational flying organisation geared to a 90 year old training system that is based on the ultimate training of senior commercial and military pilots that have to be highly educated and extremely fit. It may work but it will work a damn sight better if fully orientated to the student demand market!
   
   
  
• The direct implications of the above is a reorganisation of the flying training syllabus and consequent impacts on instructor training that will consequentially impact on the focus of training of this area.
   
   
  
• Absolute key factors are methodology being orientated to weld together, at ab-initio level - physical skills flying training with BAK and at instructional level physical instructional skills with PMI (Principles and Methods of Instructing). At present there is a huge and costly gulf in both areas that is really stuffing the contract! That is not to say the system is not working – it obviously is – what I am discussing here is orientation and efficiency of the system.
   
   
  
• So a Movement decides to go that way! There are then two separate elements – the controller (in our case the Board) that can make the decision and sorts out the wherewithal to do it, and the activators (in our case the CEO and Ops Manager). All of these have to be in accord. That can be done relatively easily.
   
   
  
• Now we hit the hard bit. All of our in-field operators have been trained by a method that has trained hundreds of thousands of pilots, they got through themselves, they have established beliefs and mode of working and will be reluctant to change and learn new methods. You CANNOT change that overnight – particularly the highly experienced ones who in turn will influence those that they control.
   
   
  
• You most certainly cannot make the change just by seminars etc, nor band aid patches of ‘advanced pilot training’! It has to be far deeper and seriously planned.
   
   
  
• I am not going to bore everyone rigid by detailing how it could happen because that will involve the ‘instructional pyramid of control’ diffusing steadily downwards from the top. I also do not believe that could happen under the present structure – we would have to go Regional and draw in our senior members, get them involved and then they can work on down.
   
   
  
• Probably above all – we would have to look at this as something that could not happen in weeks nor months. We could get positive results within a year but in widespread terms I believe it would take five years (maybe a little less) before we were starting to get uniform coverage and the members are across the board getting what they want.
   
  

 

 

That is the cliff and it always stops this sort of thing. You do not turn over a 90 year legacy easily no matter how important it may be to do so. To do it will require rational lateral thinking, determination and a firm management plan to get there. I still believe it could be done but damn it would be tough! At the end of that road is your realistic ‘safety culture’ that we could then nurture and add to.

 

 

I have said enough – so much more that I could or perhaps should have added but that will do for now.

 

 

Keep taking the tablets and applying the lotion – you will feel so much better for it!

 

 

Aye

 

 

Tony

 

 

[farri]

Inflight Safety Culture.

 

What are we realy talking about here,What is it that`s wanted,is it something like the, "Workplace Health And Safety" act,I`m starting to loose sight of the purpose of the issue.

 

Frank.

 

 

[Guest TOSGcentral]

I dunno where this is going Frank or what is wanted out of it.

 

But if it started to once more go down the track of 'lets have major changes' then I wanted to get in early this time and underline that the ain't no magic wands!

 

A single instructor adopting practical and considered methodology (plus having perhaps the status/circumstances to do so) simply comes out the other end possibly appearing to be a bit above average and probably has some impact on a localised safety culture.

 

Applying a major methodology revision to an entire movement is a considerably different matter. It is a bit like milking a cow - success depends entirely on first securing a firm stance and position plus having a firm grasp of the essentials!

 

It could be done but damn it would require some vision and determination.

 

As an aside that was exactly what Mike Valentine had already embarked on doing for us when unfortunately some personal factors got in the way.

 

Aye

 

Tony

 

 

[farri]

Tony,

 

As I see it,the whole idea of Recreational Aviation has changed from what it was originaly intended to be.

 

There`s no chance of developing a system that will take care of every issue or member,I wouldn`t want the job and I don`t think that there`s many who would,I believe the RAA is trying to manage too many interests.

 

On the issue of keeping students satisfied with their training then wanting to continue flying,we need to go back and ask,what was the original concept?, and it was,basically, minimum requirement,(FUN FLYING).Who thinks that is what it realy is today?.

 

I never lost a student due to my teaching methods,even though I required a high standared of ability,I made it fun.In my opinion a good instructor works with the student not the system.

 

I must say,truthly,that I realy don`t know all the answers to a lot of the questions we now face,we`re playing a different ball game,let`s just keep throwing the issues around and see what we get.

 

Frank.

 

 

[Guest pelorus32]

I think we should talk about both "What" and "How" as separate but linked issues.

 

In some ways I see "what" we want to achieve as a pyramid: at the bottom is the set of competencies that every pilot needs to have in order to be safe and effective. So if you are going on to be a heavy metal pilot you will still likely start in just the same way as if you were going to be a happy Sunday flier (and yes I do know about the Multi-Crew proposals but see them currently as an exception not the rule).

 

So I'm going to claim that we all need roughly the same "what" - it's just how advanced that "what" becomes that is different depending on destination. In other words it's how far up the "what" pyramid that we progress that differs.

 

Then there is the "how" do we impart that "what". This is in my view the important bit. Through the 80s and 90s some very entrenched professions adopted changes to the "how" they got to the "what". The work of people like David Kolb and Kurt Lewin was used as the basis for change. Newcastle uni moved to an experiential approach to training doctors - scenario based, in the wards from early years, team based etc; McMaster Uni in Canada did the same thing and people like Richard Bawden applied similar approaches to training agricultural scientists at UWS, Hawkesbury.

 

Medical training is a very interesting thing. The Government wants to set standards and to know that you are competent to be let loose on the unsuspecting public; doctors trained the "old way" will be convinced that others trained differently will be lesser beings. But the bottom line is that so long as you have the requisite "what" then you can be trained any way people choose within ethical and moral limits.

 

So here's my challenge: I believe that there is nothing to stop an instructor changing the "how" so long as they demonstrably achieve the requisite "what". Nothing that is (other than ethical/moral limits) except their own capacity to conceptualise and actualise an alternative "how". I don't believe that system wide change is necessary to achieve changes in individual instructional practise. It would certainly help but is not a necessary prerequisite. Interestingly the hurdle in terms of instructor capacity to act is higher without system wide change.

 

Now circling right back. As a product of an alternative "how" in my professional life, I am deeply grateful for having come through that alternative training system. Interestingly whilst I quantitatively have the requisite "what" I am certain that in qualitative terms that "what" is different and better because of "how" I got there. I am more effective at utilising that "what" and conceptualising approaches to solving problems and interacting more effectively. Kind of torpedoes my argument that the "how" can change without impacting the "what".

 

Regards

 

Mike

 

 

[Guest TOSGcentral]

A couple of responses to input on a thread that had an indeterminate beginning but is covering valuable areas – at least my opinion.

 

 

Frank – Aye mate, you did it solid and have a fine reputation from what you did. Like you I grieve somewhat on where things have gone. Not just from where they have gone or how that was done, but because it was done with so little thought to the practical consequences that dreams have to be underlined with reality and so the means that they can be brought to reality!

 

 

If that is in place then it can be fun – but can and maybe must be a weird form of fun rather than entertainment – one of obtaining satisfaction by demonstrated achievement!

 

 

I normally start students a bit radically. By stating that flying is not a Black Art nor does it require superhuman powers – in principle it is no more difficult than riding a bike or driving a piece of plant – just a machine you must learn how to control and that in fact the machine does most of the ‘flying’ work for you!

 

 

I then followed on to say that work would be involved and I would drive the individual harder than a drover’s dog to learn what must be learned to save them time and money. I got away with that because I made it obvious in what I did that I was working as hard as the student and working with the student as a team member to reach an objective. Even students so many others had rejected did respond to that and I had precious few failures.

 

 

Mike (Pelorous) your words are music to my ears and stopped me in my tracks. I have been preaching the difference between ‘what’ and ‘how’ for over 30 years as the actual fulcrum of what effective training is really all about. Your words make me feel less lonely because development is a most lonely place!

 

 

I would only go further to add that the ‘what’ must to be shaped to the actual objective and then becomes almost inflexible. The ‘how’ is then sculpted to the ‘what’ for expression and effect (the sort of thing Frank is talking about).

 

 

That can happen at a number of levels – Prime communication skills and methodology (that can be taught easily enough if you have the right means of so doing), conviction of what you are doing is totally right within the environment that you propose doing it, and personal motivation/integrity to teach at the best of your ability – for the student not yourself. Your only reward will be the satisfaction of seeing someone fly free in safety!

 

 

Aye

 

 

Tony

 

 

[Yenn]

Thinking back to my training for GA and later to change over to AUF, there was one thing which really upset me. That was the inability of some instructors to be on time and prepared.

 

I was lucky in my basic training, where the instructors were very professional, but later endorsements and check flights were often very poor. It was not unusual to have to wait an hour for a plane to be available although it had been booked days before

 

The story with AUF was woeful with my first attempt, the instructor was seldom ready and was not at all professional, after wasting a few hours I found another instructor with a much better attitude.

 

The sad part is that other students consider the poor instructor to br good because they know no different.

 

 

[skybum]

the poor instructor to be good because they know no different

And there lies the rub!

[farri]

"GOOD AND BAD IS RELATIVE",there also lies the rub.

 

There will always be good and bad in everything and in everyone in life and in my opinion,no system will ever change that,no matter how well meaning it is.

 

GA flying schools don`t come any better than one we have in our area ,the CFI is a friend on mine since our teens,instructing has been his life and always will be.

 

Over the years I`ve had people complain, bitterly to me, about what they perceived to be, bad instruction and behaviour from that school.?????

 

I`m only trying to make a point with that example,nothing else.

 

To the What and How.

 

If we`re going to talk about the "What and How" I think we need to discuss what the "What and How" is or I dont think there`s much point in the discussion other than to pass the time,what are we going to achieve,please explain it to me.

 

Frank.

 

 

[Kelvin]

Inflight Safety Culture

 

Frank,

 

In my profession (OHS) I have come to believe training standards must be kept abreast of performance based technologies. Where we started with Safety Programs (PPE) after WWII and went onto Technology (LOTO), Leadership (DuPont), Regulation (DOL/WorkSafe), Psychology (BBS) and Safety Systems. These steps have served us well but not as well as they could have. Now, the focus is on Sociology (Culture) that impacts on both organisational attributes and individual attitude towards safety.

 

This thread from 23.4.08, went off in another direction on an issue I think was simmering below the surface and beyond my level of experience in civil aviation. While I felt I could not contribute, I found it (CFI structured training) a compelling topic and would like to participate in after I have 100+hours under-my-belt. So, I'll start another thread on my particular interest in human factors and pilot error.

 

Kelvin with regret, in so far as my contribution to this thread.

 

 

[farri]

Safety Culture.

 

Thank you Kelvin,

 

I will accept that any thing or any way that can improve a safety culture is worth the effort.

 

I have just,simply been trying to say, that any system is only as good as those that it`s aimed at, wanting to apply it, and play the game,so to speek.

 

Frank Also.

 

 

[Yenn]

My experience with the safety culture has left me far from impressed. Rather than us working out how to do something safely the "experts" now want us to think it all through in advance, write it all down and then strictly adhere to the written word. All well and good if the problem is something we have envisaged, but it all falls apart when something unexpected happens. In industry it seems to be a case of "cover my backside"

 

 

[Kelvin]

Thanks Ian,:thumb_up:

 

I suppose we are talking about a Job Safety Analysis which is supposed to be a co-operative effort on what are the forseeable risks, particularly with new tasks. But it is only a prevention tool and I agree it can be misused to setup a blame scenario. On the other hand, industry that is culturally sensitive has no place for blame, you would hope.

 

Pilot error is usually the behavioural component of incident cause that is just as important as the design and enviroment cause elements. Our navigation is now helped along with GPS because we know navigational errors are most likely to occur when things start going wrong during flight. Thats what I'm interested in, systems that addresses pilot error under stress, not while everything is going according to plan.

 

Kelvin (with a long way to go)

 

 

[Guest High Plains Drifter]

Our navigation is now helped along with GPS because we know navigational errors are most likely to occur when things start going wrong during flight. Thats what I'm interested in, systems that addresses pilot error under stress, not while everything is going according to plan.

Im a little confused here Kelvin. With this thread, are you talking about how a pilot reacts to a problem with the aircraft, or, how the pilot reacts to a navigation error - which is a problem with the pilot. And I think a GPS failure that causes nav problems IS a problem with the pilot.

 

 

[Kelvin]

Perhaps HPD I think more to the point would be a pilot delayed reaction to either an aircraft or navigational problem. I have just read an article from www.asf.org Safety Advisor Operations & Proficiency No 11 called "Do The Right Thing: Decision Making for Pilots". I found it to very helpful with concepts that negates pilot error.

 

Kelvin (with along way to go and hope the link helps)