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You are here: Home / Articles / Boeing is Steering Harder into its Spiral of Death

by Christopher Jackson Leave a Comment

Boeing is Steering Harder into its Spiral of Death

Boeing is Steering Harder into its Spiral of Death

Boeing has somehow managed to make the bad public relations created by those pesky onboard batteries catching fire in 2013 practically disappear. Not through good management. But through a never-ending series of disasters and catastrophes that shows no sign of letting up which is dominating Boeing’s news cycle that there is no remaining airtime for missteps like those battery fires.

You probably don’t remember those battery fires. But anyone keeping their ear to the ground for everything that has followed probably should. 

So what happened? Back in 2013, lithium-ion batteries that were designed into Boeing’s 787 Dreamliners started catching fire. This is not really uncommon for lithium-ion batteries (see all those burning Tesla vehicles that entire fire brigades can’t put out). 

And what was the legacy of these incidents? The US Federal Aviation Administration or FAA copped criticism for not recognizing the hazard of these well-known ways lithium-ion batteries can (catastrophically) fail, even though everyone who has a cell phone is aware of what can happen. It turns out that the FAA did not mandate tests or anything similar in the certification process to account for any potential battery fire. Then there was the supplier who provided these batteries who also wore some of the blame. They used manufacturing methods that really weren’t the best, meaning the batteries were likely to have defects to cause these fires. And then there was Boeing, who essentially approached designing these aircraft by assuming that potentially bad things (like battery fires) simply would not happen.

Does this sound familiar? 

The most recent Boeing related issue is that the rudder controls for a Boeing 737 Max briefly stopped working. That is kind of a big deal. And remember that emergency door plug that flew off mid-flight? Well, Boeing is really struggling to provide the US Senate with a list of people who were involved in the plug’s installation and maintenance (something that the FAA unambiguously requires) along with other documents. 

On the list of plausible scenarios behind this delay (and the radio silence associated with it), it is hard to look past anything besides Boeing simply not ever raising that paperwork in the first place.

Boeing is still avoiding the hard decisions it needs to make. Of the 13 current directors, five of them were in their board member before the two catastrophic 737 Max crashes killing all aboard each aircraft. These five include the current board chair and CEO. The former CEO at the time of those crashes was fired (begrudgingly and with a huge payout). So what is the point of having a board of directors whose responsibilities include keeping tabs on people like the CEO? If his behaviour was so egregious that it initiated a direct, causal link to those two 737 Max crashes, then it is impossible to conclude anything but the then board of directors was fundamentally incompetent.

And yet, they are now in charge. Still.

All this (and lots of other issues that deserve mention in this article, but we don’t have room for) suggests is that Boeing is in ‘crisis-management mode,’ and not ‘first principles review mode.’  What is the difference between the two? ‘Crisis-management mode’ is all about managing perceptions and trying to demonstrate that ‘steps are now in place’ to ensure that specific problems can never happen again. ‘First principles review mode’ is all about looking at the fundamental culture and leadership behaviours that allow these problems to occur in the first place. And Boeing isn’t doing this.

If we go way back in time to NASA’s Apollo program, three astronauts were killed in the command module of the first spacecraft designed to go to the moon (Apollo 1). They died when a fire broke out during a test, caused by faulty wiring in a pure oxygen atmosphere. This (like the lithium-ion fires and all the other maladies Boeing has since experienced) was entirely predictable and not really treated seriously by NASA beforehand.

NASA’s then Chief Flight Director was Gene Kranz and was a key character in the ‘Apollo 13’ movie. And this is what he said after the death of the three astronauts …

We were too ‘gung-ho’ about the schedule and we blocked out all of the problems we saw each day in our work. Every element of the program was in trouble and so were we.

He then delivered these words as part of a speech to his Mission Control Staff …

From this day forward, Flight Control will be known by two words: Tough and Competent. Tough means we are forever accountable for what we do or what we fail to do. We will never again compromise our responsibilities … Competent means we will never take anything for granted … Mission Control will be perfect. When you leave this meeting today you will go to your office and the first thing you will do there is to write Tough and Competent on your blackboards. It will never be erased. Each day when you enter the room, these words will remind you of the price paid by Grissom, White, and Chaffee [the three astronauts who died.] These words are the price of admission to the ranks of Mission Control.

This meant engineering started to rule again. If something could not be done safely, then schedules would be pushed back and so on. Suffice to say, this sentiment of leadership offers a clear contrast to the carefully managed silence of Boeing over the last 15 years or so. 

The reality is Boeing needs a new direction and new leadership. The mosaic of issues its aircraft has experienced is not tied to a single airframe, or a single technology on an airframe. And even if the current board of directors has some capacity to head in a new direction, such a fundamental change needs at least some symbolism that wholesale replacement of directors would provide.

There are lots of lessons to be learned here, starting with the fact that the laws of physics don’t change, nor can the risk they are crucial in determining cannot be reduced by changing a score on a risk management framework.

But if you are somehow tied to an organization where the leaders and the problems they create both hang around like bad smells, then drastic action is needed. If the leaders don’t go, then perhaps you need to. 

Or at least book flights with Airbus aircraft …

Filed Under: Articles, on Product Reliability, Reliability in Emerging Technology

About Christopher Jackson

Chris is a reliability engineering teacher ... which means that after working with many organizations to make lasting cultural changes, he is now focusing on developing online, avatar-based courses that will hopefully make the 'complex' art of reliability engineering into a simple, understandable activity that you feel confident of doing (and understanding what you are doing).

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Article by Chris Jackson
in the Reliability in Emerging Technology series

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