I apologize for being about two topics behind in my response but my 767
upgrade training has occupied all my attention while these excellent
discussions have rolled on. I would like to revisit the discussion on
error management CRM. After reading Professor Reason's work and listening
to his lectures a couple years ago, I began searching for many of the
answers that have been expressed in this group's discussions on error
management. Most quests for answers lead to many more questions. This one
was no exception. I would like to share with you some of the questions
that surfaced before addressing some of the answers. How would you answer
the following questions?
1: Does CRM fit into a larger corporate error management program or should
the entire corporate error management program be built within a CRM
program?
2: Who in the organization would need to be responsible for an error
management program so that appropriate organizational level issues could be
adequately addressed?
3: Can an error management program that is built in one portion of an
operation (e.g. flight ops) survive and provide any significant benefit
without a larger corporate error management support structure?
4. Are the CRM training developers the right people to build a corporate
error management program?
5: Will a CRM program stall if it is burdened with the weight of something
it cannot accomplish logistically or politically within an organization?
6: Is it appropriate or prudent to expand the boundaries of CRM programs
beyond individual and crew skill development to include organizational
error management responsibilities?
My conclusion was that CRM and error management were really two separate
yet complementary programs. Most of the U.S. Military Services have
tackled these as two separate programs (ORM & CRM). The use of the term
"Error Management CRM" is like saying ORM/CRM. It's a force fit that
dilutes the value of both programs.
The guidance offered by Professor Jim Reason provides some basis for
understanding where CRM fits in the scheme of error management. Professor
Reason highlights that error management happens at three levels:
1: The Task 2: The Workplace 3: The Organization
CRM is a "TASK" level program that affects the workplace and the
organization.
>>>>>>Move this way on the Reason hierarchy>>>>
Error Management is an "ORGANIZATION" level program that affects the
workplace and the task.
<<<<<<Move this way on the Reason hierarchy<<<<
To build successful error management programs we must recognize these
distinctly different levels and tailor our approach to each. It is
critically important for us to recognize that different people within the
organization make each of these three levels work. While some CRM'ers
might find a comfortable place at the error management development table,
the skills for error/risk management development are significantly
different those for CRM development.
The U.S. Air Force recognized that CRM is not the appropriate tool to shape
organizational-level error/risk management so they made ORM (operational
risk management) and CRM complementary yet separate programs. An esteemed
Air Force colleague of mine (Maj. Ken Bauer) summed up this complementary
relationship between the programs when he said "ORM is what happens behind
the duty desk and CRM is what happens in front of the duty desk." (Duty
desk is where we sign out to go flying in an Air Force squadron). ORM
focuses on leadership policies, procedures, and practices that have an
adverse effect on operational behavior. ORM is designed to address
"organizational-level" issues. It targets leadership directly. It
provides tools that leaders can use to shape the organizational.
CRM is a task-level program. Trying to redefine CRM to address
"Organizational-Level" error management issues will never work. The
audiences, needs, and requirements are completely different. That is why
currently postulated "Error Management CRM" is a force fit that will not
ever live up to its promises. Error management CRM as it is currently
postulated is a skill-level program that is trying to be more than it
really is, or ever will be. In fact, putting the two terms together could
be seriously detrimental to the progress of viable corporate error
management programs. CRM has some serious negative baggage associated with
some of the folly over the past 10-15 years. As a result, management has a
predefined notion of CRM. They also have a predefined notion of the
utility of CRM. The utility of organizational-level error management is
completely different than the utility of skill-level CRM. Attaching the
baggage of CRM to viable error management programs that target their
approach and solutions at the leadership and organizational level is a
mistake.
Now that the industry has recognized the futility of attitude-centered CRM
programs and began developing skill-centered CRM, error management at the
task level is (by default) represented in skill-centered CRM programs
vis-ˆ-vis the CRM management skill lists. There appears to be no
disagreement that the CRM skills we would use and teach under the newly
postulated "Error Management" approach to CRM are no different. I agree
with the general group consensus that it is old wine in a new bottle.
I have some tips for how to make the complementary relationship between ORM
and CRM work but this message is already too long. More to follow....
I look forward to your comments,
Vince Mancuso