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S U M M A R Y


DIARY: August 28, 2003 08:49 AM Thursday; Rod Welch

NASA "gets it" that culture must change from denial to improvement.

1...Summary/Objective
.....Gets It that NASA Culture Must Change to Improve Safety
.....Attitudes on Vigilence to Slips Because Success Imparts Security
.....Success Imparts False Sense of Security Causing Vigilence to Slip
.....Vigilence Slips with Success that Imparts False Sense of Security
.....What is the "It" that NASA Got from the Report on Columbia??
.....Tragedy Loss Bring Vigilence Until Success Creates Atrophy Entropy


..............
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CONTACTS 
0201/- Boeing                                                                                                                                                             O-00000816 0505
020101 - Mr. Garold L. Johnson
020103/- Modeling and Simulation                                                                                                                                          O-00000816 0505

SUBJECTS
Columbia Shuttle Exploded ISS International Space Station
Columbia Shuttle Review Board Reports NASA Management Culture of Deni
Cultural Drift Daily Work Not Aligned Meaning Drift Compounded and Pr
Management Culture of Denial Contributed to Loss of Columbia Space Sh
Lessons Learned Review Board Columbia Shuttle Reports NASA Management
Good Management Unnecessary Overkill Culture of Denial NASA Managemen
Denial Ignorance Fear Intelligence New Way of Working Funny Foriegn A
Improve Loathe Frustrating Learning New Way Working Change Hand Eye M
Gets It Nasa Management Understands Safety First Does Not Get It that
Columbia Space Shuttle Loss Nasa Management Gets It Understands Safet
New Realities New World Order Information Overload Good Management Re
Vigilence Funding Diverted by NASA for Prevention Proactive Managemen
NASA Doesn't Get It New Realities New World Order Information Overloa
Culture Resists Re-tooling Personal Skills for Learning Literacy Peop

7016 -
7016 -    ..
7017 - Summary/Objective
7018 -
701801 - Follow up ref SDS 19 0000. ref SDS 17 0000.
701802 -
701803 - Article published by Reuters yesterday reports on NASA reaction to
701804 - findings by the Board of Review commissioned to determined the cause
701805 - of failure when the Columbia Space Shuttle exploded during re-entry on
701806 - 030201. ref SDS 13 0001
701808 -  ..
701809 - Reuter's article says...
701811 -      ..
701812 -     Gets It that NASA Culture Must Change to Improve Safety
701813 -     Attitudes on Vigilence to Slips Because Success Imparts Security
701814 -     Success Imparts False Sense of Security Causing Vigilence to Slip
701815 -     Vigilence Slips with Success that Imparts False Sense of Security
701816 -
701817 -     Follow up ref SDS 19 1G9L
701818 -
701819 -     WASHINGTON -- Space agency administrator Sean O'Keefe said NASA
701820 -     will, without reservation, follow the recommendations of the
701821 -     Columbia Accident Investigation Board, including a major
701822 -     renovation of NASA's culture. ref OF 2 0001
701824 -      ..
701825 -     "We get it," O'Keefe said Wednesday at a news conference. "We
701826 -     clearly got the point." ref OF 2 FC5F
701828 -      ..
701829 -     He said the report clearly spells out NASA's human failures and
701830 -     how its culture must change to assure safe human spaceflight.
701831 -     ref OF 2 IC5J
701832 -
701833 -        [On 030830 progress reported on changing the culture at Aerospace company
701834 -        by empowering people to experience benefits of a new culture
701835 -        without making any effort. ref SDS 20 PPWS
701836 -
701838 -      ..
701839 -     What is the "It" that NASA Got from the Report on Columbia??
701840 -     Tragedy Loss Bring Vigilence Until Success Creates Atrophy Entropy
701841 -
701842 -     Follow up ref SDS 19 HH4I
701843 -
701844 - The primary challenge for NASA is to define the "it" that determines
701845 - what they "got" out of the Board's report, per above. ref SDS 0 OA8I
701847 -  ..
701848 - NWO defines "it" as new realities of a new world order where skills
701849 - using information technology in meetings, calls and email that
701850 - formerly brought success are now no longer effective, ref OF 14 02CV,
701851 - and in fact popular tools and methods greatly compound problems by
701852 - overwhelming human span of attention, as explained in POIMS.
701853 - ref OF 8 049O  The only solution is to speed up the process of adding
701854 - intelligence to information that creates knowledge people need to cope
701855 - in a faster, more complex world, and this requires a new set of tools
701856 - and practices, which up until have been resisted as "overkill" by the
701857 - mainstream culture.  Meaningfull change requires transformation from
701858 - denial of improvement as "overkill by making the transition from
701859 - information to a culture of knowledge.
701861 -  ..
701862 - O'Keefe's commitment is hollow without effort to provide tools
701863 - required to expand span of attention to, as Drucker says in his
701864 - article reviewed on 991025, empower people to routinely work
701865 - intelligently by capturing a greater share of daily working
701866 - information and create the connections that generate understanding of
701867 - cause and effect for organizational memory.  Only tools and procedure
701868 - can overcome the inevitable decline in vigilance warned in the report
701869 - issued by the Columbia Board of Review reported on 020826. ref SDS 19
701870 - HH4I
701872 -         ..
701873 -        [On 030830 progress reported on changing the culture at Aerospace company
701874 -        by empowering people to experience benefits of a new culture
701875 -        without making any effort. ref SDS 20 PPWS
701877 -  ..
701878 - Examples of resistance to cultural change are...
701879 -
701880 -    1.  On 890324 improving bad management by adding "intelligence" to
701881 -        information for getting things done correctly, on time and
701882 -        within budget seems like overkill. ref SDS 1 8R97
701883 -
701884 -    2.  On 890809 improving management is resisted because people are
701885 -        too busy to learn good management practice, ref SDS 2 EB6K;
701886 -        doing more than being a good talker seems like overkill.
701887 -        ref SDS 2 6W42
701889 -         ..
701890 -    3.  On 921021 NASA reported changes were instituted that required
701891 -        extensive reporting and audits to improve bad management and
701892 -        poor communications that caused the loss of the Challenger
701893 -        Space Shuttle in 1986. ref SDS 3 4499  At that time in 1992,
701894 -        NASA, also, reported that managing communications was a "sore
701895 -        subject," because the problem is too complex. ref SDS 3 4390
701896 -        Disparity between committing to improve management and failure
701897 -        to manage communications, doomed the space program to failure,
701898 -        because communication is a predicate to action, noted in NWO.
701899 -        ref OF 15 MY6H
701901 -         ..
701902 -    4.  On 950204 executive management seminar that recommended using
701903 -        SDS methods of adding "metrics" to align communication was
701904 -        ignored because adding "intelligence" to management seems like
701905 -        overkill. ref SDS 6 0Y03
701907 -         ..
701908 -    5.  On 991001 NASA lost an unmanned space probe to Mars due to a
701909 -        little deviation, ref SDS 9 0001, that occurred becasue
701910 -        communication, which was a "sore subject" beginning at least in
701911 -        1992, was not aligned with requirements. ref SDS 9 3077
701913 -         ..
701914 -    6.  On 030222 NASA lost the Columbia Space Shuttle when email was
701915 -        ignored that analysed problems during launch, because
701916 -        communication is a "sore subject" beginning in 1992.
701917 -        ref SDS 14 0001
701919 -         ..
701920 -    7.  On 030304 NASA Chief administrator, Sean O'Keefe disclosed that
701921 -        email communications that analysed problems during launch, and
701922 -        which were later found to have caused the Columbia Space
701923 -        Shuttle to fail, were ignored by management because informal
701924 -        communication is emotional and can be taken out of context.
701925 -        ref SDS 15 DM4F  Adding a system of "metrics" to daily
701926 -        communication for context management, explained on 950204,
701927 -        ref SDS 6 8A4G, is a lot of hard work using conventional
701928 -        information technology that everybody likes, reported on
701929 -        000307. ref SDS 10 5182  Since people generally avoid hard work,
701930 -        reported on 010908, ref SDS 11 YF5O, investing time to analyse
701931 -        communication is a "sore subject" that looks like "overkill"
701932 -        using NASA's methods for formal analysis, and so the analysis
701933 -        didn't get done to either prevent problems nor to save the
701934 -        Columbia when problems became evident at launch time, as
701935 -        related in reporting on 030304. ref SDS 15 IM5J
701937 -         ..
701938 -    8.  Federal Acquisiton Regulations (FAR) require the government and
701939 -        contractors to use good management practice capturing daily
701940 -        working information in a record of organizational memory and to
701941 -        maintain an audit trail showing traceability to original
701942 -        sources that establish conformance of the work with
701943 -        requirements, reviewed on 020504. ref SDS 12 XV7L  Evidence
701944 -        shows that these requirements are ignored, because good
701945 -        management is a lot of hard work using information technology
701946 -        everybody likes. ref SDS 12 NS6F
701948 -         ..
701949 -    9.  If the government cannot enforce nor follow existing rules on
701950 -        the books for using good management, because implementation is
701951 -        too hard using information technology that everybody likes
701952 -        under new realities of a faster paced world, if issues of life
701953 -        and death cannot motivate doctors to overcome a culture of
701954 -        denial in medical practice that prevents improving healthcare,
701955 -        reported on 990912, ref SDS 8 3416, if everyone on the planet
701956 -        has given up on improving communication, noted by Drucker on
701957 -        931130, ref SDS 5 3851, then what force of nature can empower
701958 -        Sean and other leaders to retool practices for working
701959 -        intelligently at NASA under new realities that prevent skills
701960 -        that formerly brought success from being successful in the new
701961 -        world order of the 21st century? see NWO, ref OF 14 TQ4O
701963 -         ..
701964 -        Andy Grove notes that, unlike Sean O'Keefe's comments today
701965 -        about people at NASA, executives at Intel just don't "get it"
701966 -        that new realities require retooling to improve skills,
701967 -        reviewed on 980307. ref SDS 7 GW7H  Grove says that cultural
701968 -        viscocity to work on familiar things in familiar ways makes
701969 -        getting talented people to improve like walking through the
701970 -        Valley of Death. ref SDS 7 1657  More recently, on 030813 there
701971 -        was a report that people prefer to let problems escalate into
701972 -        loss, crisis and calamity, and then clean up the mess using
701973 -        existing skills. ref SDS 18 2G9U
701975 -  ..
701976 - Given the weight of this history, what does NASA plan to do
701977 - differently this time around to overcome resistance to improvement?
701978 -
701979 -        [On 030830 progress reported on changing the culture at Aerospace company
701980 -        by empowering people to experience benefits of a new culture
701981 -        without making any effort. ref SDS 20 PPWS
701982 -
701983 -
701984 -
701985 -
701986 -
701987 -
701988 -
701989 -
701990 -
7020 -