Safety Culture
When we think about a major incident or catastrophe, we often try to attribute this to a single cause, a major event. Such simplification is a normal human tendency. However, in reality, post event analysis reveals that it is often a combination of small errors that caused the incident.
For example, when there is a plane crash in the movies, it is usually due to a single event such as engine failure or a build up of ice on the wings. In real-life, many plane crashes are the result of a series of seemingly minor errors. This is true not only of plane crashes, but of a number of major incidents.
Post-incident analysis has repeatedly highlighted one vital element which would have significantly reduced the chances of a catastrophe taking place - creating the right safety culture. Safety depends on effective teamwork and communication, which must be appropriate for the operating environment. In order to bring this to life, let's take the airline industry as an example. In the 1980's and 1990's Korean Airlines had a poor safety record, with plane crashes over seventeen times more likely than for United Airlines.
On analysis of the incidents, it became apparent there were combinations of 3 factors that usually led to the incidents: A minor technical malfunction, a tired pilot, and bad weather. Alone, none of these would cause a significant accident. All three in combination require the combined efforts of everyone in the cock-pit to avert catastrophe. However, in a series of Korean Air incidents the communication and teamwork failed to do this.
Korean culture is highly deferential toward authority and seniority, something that is ingrained in many customs and practices in Korean society. However, in the cock-pit, particularly in times of stress and fatigue, such deference can lead to unclear communication: particularly between pilot and co-pilot. Black box recordings from flight KAL 801, which crashed into the side of a mountain in 1997, clearly illustrated the communication problem. The co-pilot was recorded as 'hinting' at a problem and asking 'polite questions'. Information did not flow between pilot and co-pilot effectively which meant that critical actions were not taken in time. This was not Korean Airlines only significant loss.
In 1994, Boeing published safety data showing a clear correlation between a country's plane crashes and its culture (as scored on Hofstede's Dimensions - a scale that measures the way that cultures differ from one another).
What these examples show is that there are tendencies, assumptions and reflexes handed down to us by the society we grew up in. It's not about a right or wrong culture, but a question of recognising that our cultural background can affect the way we act in certain circumstances - and that there are consequences to this. In the aviation industry, it is important to be directive and take command rather than suggest or hint. This is not well aligned with the inherent Korean culture.
Effective safety cultures have a number of things in common: information flow is good and uninhibited in all directions; communication is clear and unambiguous; there is a shared sense of purpose; learning is continuous and applied; there is a sense of 'fairness'; and there is shared sense of mutual respect.
In the year 2000, Korean Airlines bought in David Greenberg from Delta Airlines to take over the operations. As minor errors such as a malfunction or bad weather are inevitable and faced by every airline, he addressed the problems caused by reactions towards authority and hierarchy. He set a common language - English - used trainers from the western world to help reduce the use of mitigated speech and imposed new English titles on roles to reduce deference to authority. He created the right safety culture by providing people with circumstances to better fit their environment. Today, Korean Airlines has a leading example of airline safety, with an excellent safety culture in the cockpit.
