Capt. Rafael Santos
Crm developer
Varig Airlines - Brasil
-----Mensagem original-----
De: Keith Hendy <khendy_at_dciem.dnd.ca>
Para: crm-devel_at_db.erau.edu <crm-devel_at_db.erau.edu>
Data: Quarta-feira, 6 de Janeiro de 1999 18:09
Assunto: Re: CRM Millennium Manifesto
>
>This tack worries me. If I wanted to take religion, Zen has greater appeal
;-)
>
><snip>
>>
>> I, too worship at the altar of the Great Ones like Bob and
>>Frank - but I take different approach, and for good reason. I believe
that
>>many - perhaps most - aviators are chronic underachievers. That is to
say,
>>they will not independently seek higher standards unless at the point of a
>>gun. (This is probably based upon experience although I claim it from
>>observation! ;-]) I maintain that the PURSUIT of perfection - error
>>elimination - should be the standard. To say that there will always be
human
>>error in the cockpit leads, I believe to a tolerance factor in individuals
>>that is counterproductive, especially when it is related to the drive for
>>personal improvement and accountability.
>
>The aim for zero error is the Skinnerian model (stimulus-response), while
>goal driven error correcting behaviour is the percetual control theory
>model (I think many have read my views on these two positions before). For
>humans never to make errors they must always perceive the objective truth
>of a situation (this doesn't happen, remember the existence of illusions),
>they must always have the strictly correct action to all situations
>programmed into memory with perfect retrieval always possible (this doesn't
>happen - read the literature on memory, memory retrieval, mental models)
>and they must always be attending to all salient cues in the environment
>(this doesn't happen - relevant literature includes that on workload,
>attention, vigilance). That doesn't seem encouraging for the zero error
>view of the world. I do not believe that the accident data base supports
>this under-achiever view of the aviator at all. If I have $100 to spend I
>would rather spend it in those areas that have the greatest potential
>payoff and I believe training in the area of time, attention and knowledge
>management is that area.
>
>
>>While it may be true that all error will never be eliminated, I feel
greater
>>gain can be achieved by moving INDIVIDUALS towards higher standards -
fewer
>>errors - with the goal of perfection. Perfection doesn't necessarily mean
>>"forever" - that's too long for anyone to comprehend - BUT I as a
crewmember
>>can seek perfection for the next five minutes or for the next flight, or
for
>>the next week or month. Like they say in alcoholics anonymous "one day at
a
>>time." That is my training perspective - expect perfection - and be
>>disappointed (but not to a debilitating state) when you don't achieve it.
>>Good individuals make better teams.
>
>Indeed the position that good teams start with the highest levels of
>individual skills is a position, based on theory, that we have put in
>writing over the last year or so. Interestingly the recent material on
>communication pros and cons (refered to in a post from Vince Mancuso) is
>absolutely consistent with, and predictable from, this theoretical position
>- based on the IP/PCT model (I wrote about this in an article published in
>RAAF Safety Spotlight last year. Perhaps Neil would consider posting this
>article on the web site if there is enough interest.
>
>>Second concern - the semantics of "generational CRM." Supposedly, we are
>>now
>>in the midst of "fifth-generation CRM." This somehow connotes that all
that
>>has come before has been overcome by a newer and "better way." I
disagree.
>>New does not automatically mean "better." The fundamentals of hazardous
>>attitudes and subtle incapacitation that I saw in my very first exposure
to
>>CRM in the early 1980s are still among the most valuable tools in my human
>>factors kit bag today.
>
>I guess the success of previous generations of CRM is a moot point. I
>think the move from generation to generation was at least partly driven by
>the perception that not all things were right in the state of Denmark.
>Anyway each generation of CRM was built on the base of what went before. I
>suspect you would have to be very brave to promote a first generation
>programme to managment these days. But if you have the faith...
>
>>Finally, it is my gut feeling that error management is deals primarily
with
>>the "bottom feeders" (I know that will generate some hate mail) - i.e.
"How
>>can we take crews performing at marginal levels and keep them from killing
>>themselves and others?" Because we are limited in resources (can't train
>>both
>>the high and low ends of the performance spectrum) - and are interested
first
>>and foremost in safety - this is a necessity - but it takes away from
seeking
>>and achieving higher standards of performance. The entire American
education
>>system is in disarray due to the two decade focus on the low achiever. We
>>should not repeat this mistake. High achievers raise the level of all
around
>>them. We must not forget this fact or lose this leverage.
>
>Even surface feeders screw up (but then IP/PCT would tell us that ;-).
>Look at all the innane statements made by those supposedly at the top of
>the heap over the years...remember a leading scientist stating that humans
>couldn't fly, that human powered flight was impossible. Indeed look at our
>own archives sometime (perhaps I haven't been able to convince everyone of
>the absolute truth of the IP/PCT approach because I have been using a dry
>fly rather than a wet fly - guess I will have to change my rig ;-)
>
>>OK, OK, I'm calming down now - in reality I see the need for both
>>approaches -
>> organizational foci on risk mitigation and error management - and pushing
or
>>pulling high achievers to the next rung on the ladder to perfect
>>performance. Unfortunately we seem to be pursuing only one.
>
>I do believe, like Tony, that the critical contribution of individual skill
>levels has been lost in much of the team work literature and past CRM
>programmes. I have challenged the forums to justify the synergy position
>on several occassions and remain unconvinced. While we have these mystical
>ideas that putting two people together generates a magical multiplying
>effect we are doomed to repeat the past. The article on communication that
>Vince pointed us to rasied some of the problems in communication (critical
>to team working) in a purely descriptive way. You can't really generalise
>from the material in the article and any real condition will probably fit
>more than one of their situations. We believe that at least some
>prescriptive guidance can be derived from our theoretical position. At
>least that is what we said in our report to the CC-130 community recently.
>
>Cheers and all the best to all for Y2K-1 and the third millenium -2.
>
>
>Keith Hendy
>DCIEM
>Toronto, CANADA
>Keith Hendy
>Systems Modelling Group
>DCIEM
>PO Box 2000
>Toronto, ON M3M 3B9
>CANADA
>
>Ph: 416 635 2074
>