Improving Air Safety through Organizational Learning: Consequences of a Technology-led ModelThe key theme of this book is organizational learning and its consequences for the field of aviation safety. Air safety rates have been improving for a long time, demonstrating the effects of a good learning model at work. However, the pace of improvement has almost come to a standstill. Why is this? Many safety improvements have been embodied in technology. New devices and procedures appear almost daily, yet the rate of air safety improvement has dragged in recent years. Improving Air Safety through Organizational Learning explains this situation as being the consequence of a development model supported chiefly by information technology being introduced as an alternative to human operators. This is not a book about the convenience of including or not including IT in aviation, but an open discussion about the adequacy and risks of some practices in the field. Two different but complementary issues emerge. Firstly, a real improvement in air safety requires a different approach, since the present one seems now to be exhausted. Secondly, the current approach has powerful economic roots, and any new approach must deal with this fact, improving safety rates without becoming financially damaging. Consequently the book is divided into two parts. Part one deals with the issue of the present learning model organizing the conclusions around accident reports that show themselves the existence of a problem: the present use of technology makes the system better at doing things already known, while at the same time it makes the whole system worse at dealing with unplanned situations. Part two suggests a new development model, one that makes strong use of technology but at the same time questions every step: what knowledge will disappear from the system and what is the potential effect of that loss? |
Contents
Commercial Aviation A HighRisk Activity | 1 |
Air safety as a model of successful learning | 3 |
Limitations to success in organizational learning | 4 |
Reductions in the rate of improvements in safety levels | 10 |
The reduction in the rate of learning as consequence of a model | 12 |
Event Analysis as an Improvement Tool | 15 |
Life cycle of information on events | 20 |
Limitations of eventbased learning | 29 |
Paradigms and modes of action | 110 |
Adjustment of the different organizational paradigms to the needs of learning in air safety | 112 |
Organizational Learning in Air Safety Lessons for the Future | 117 |
Change of organizational paradigm | 123 |
Meaning and Trust as Keys to Organizational Learning | 129 |
Role of trust in organizational learning | 141 |
The Future of Improvements in Air Safety | 145 |
Determinant factors of learning ability | 147 |
Safety in Commercial Aviation Risk Factors | 35 |
Classification of risk factors | 36 |
Analysis of risk factors | 38 |
Summary of the treatment of risk factors | 89 |
Explanation of the Reduction in the Rate of Learning in Complex Environments | 91 |
Barriers to organizational learning | 94 |
Organizational paradigms and their role in learning | 108 |
Alternative learning model | 149 |
Conclusions | 159 |
Changes in the relationships between variables within the system | 160 |
Future lines of development | 162 |
Final conclusions | 163 |
References | 167 |
177 | |