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Mark
Thanks for your reply.
Below is a response and I have
included my further points in yours in caps below.
BUT .......... (a) How about you play
the ball and not the man. Argue your case by all means but don't demand to win
and don't attack the contributor because they continue to argue
theirs.
(b) It is interesting that my Poll
on The Gliding Forum was 21 votes from people who think that Incident and
Accident Reports are useful and 2 that don't. 91.3% in favour and given that 1
of the nay-sayers might have been you voting twice, I reckon that's strong
support for the concept ......... but then what do I know in my
vacuum?
You and the other no-voters can have
a meeting in a phonebox somewhere.
I apologise to the other readers but
Mark has demanded a response to each of his points.
See other comments below in
CAPS
Regards Geoff
----- Original Message -----
Sent: Monday, November 07, 2005 12:56
PM
Subject: Re: [Aus-soaring] ACCIDENT &
INCIDENT REPORTING
Geoff Kidd wrote:
> I suggest that the main question
for the GFA Board and the Management is
> something like "What is in the
best way to build a safety conscious culture
> in the interests of all
of our members" and I say that regular factual
> reporting is a good way
to do that.
See, this is the problem with having discussions like this
on mailing lists.
Mailing lists tend to favour people who argue their point
of view in a
vacuum, without considering any counterpoints. THAT'S THE
KETTLE CALLING THE POT BELLY BLACK
I've already described a couple of
reasons why "regular factual reporting"
of the kind you've proposed is
bad. To whit:
- It discourages people who are
"sensitive" about humiliation from
reporting
accidents/incidents in the first place;. THIS IS NOT RELEVANT AS I THINK THAT
THE CTOO SAID THAT THEY CAN BE ANONYMOUS IF NECESSARY.
-
It relies on people getting hurt or killed to get its point across.
WRONG. I AM NOT ARGUING THAT ONLY INJURIES OR FATALITIES ARE REPORTED TO
MEMBERS. SOME MAY BE THOSE TYPES OF OCCURANCES, AND SO BE IT, BUT I
ARGUE THAT ALL ACCIDENTS AND INCIDENTS SHOULD
BE REPORTED TO MEMBERS.
- It adds responsibility for
extra workload to people who are volunteering
their time, and who probably don't appreciate having their spare
time
eaten up on the insistence of other people
who aren't volunteering theirs. THAT WOULD BE VALID IF IT WAS FACTUAL. THE
CTOO ADVISED THE WAGGA SAFETY SEMINAR THAT THE DATA EXISTS, IT JUST ISN'T
REPORTED TO MEMBERS, AT THE DIRECTION OF THE BOARD. THE CTOO FURTHER SUGGESTED
THAT I WRITE TO THE BOARD TO ARGUE MY CASE. I HAVE ALSO VOLUNTEERED TO DO THE
TYPING AND COMPOSITION DONKEYWORK FOR THEM TO EDIT IN ANY WAY THEY WISH
............ AND BEFORE YOU ACUSE ME OF WANTING TO INFLUENCE THE OUTCOMES, I
HAVE NO DESIRE, NOR DO I HAVE THE EXPERIENCE TO MAKE A FACTUAL
OR EVALUATION JUDGEMENT, BUT I CAN DRAFT THE WORDS AND PREPARE THE
ELECTRONIC DOCUMENT FOR THEM TO USE AS A BASIS FOR A
MONTHLY EDIT.
- It doesn't provide any deeper insight
into safety than could be achieved
by writing
about precisely the same issues without having to wait for
an
accident to occur. I THINK YOU ARE DEAD
WRONG ON THIS. THEORY MIGHT TURN YOU ON, BUT I CONTEND THAT REAL INCIDENTS
ENCOURAGE THE READER TO ASK SOMETHING LIKE ................ WHAT WOULD I
HAVE DONE IN THAT INSTANCE AND WHY WILL I NOT GET SUCKED INTO THAT ERROR SOME
TIME IN THE FUTURE. AS AN EXAMPLE, WHY DOES THE CTOO GO TO SO MUCH TROUBLE TO
HAVE VIDEO AND SEEYOU EVIDENCE AT THE SAFETY SEMINARS? I THINK THAT THE REASON
IS THAT IT HAS MORE IMPACT AND MUCH MORE MEANING WHEN ATTENDEES SEE TRUE
EXAMPLES.
"In the real world," those counterpoints would be addressed
and incorporated
into any proposal that was finally delivered. On a
mailing list on the
Internet, though, someone like you is perfectly free to
pretend they've
never seen any of those points, and blithely continue with
their original
crusade without making a single iota of modification to
their course.
Seriously, Geoff, we might as well have never had the
discussion, because
it hasn't influenced your conclusion at all, has
it? You certainly haven't
responded to any of those points in any
meaningful way, so as far as I can
see you've totally ignored them. NOW I
KNOW THAT MY ABOVE RESPONSES WILL NOT SATISFY YOUR NEEDS FOR NON-BLITHE
CONTINUANCE BUT SO BE IT.
I think that attitude is intellectually
irresponsible. I'm pretty sure
that the ops panel will agree with
that conclusion and reject your proposal;
and when they do you'll probably
feel disenfrancised just like Robert H
does, even though the rejection of
your proposal will have nothing to do
with the intransigence of the ops
panel and everything to do with the fact
that the proposal never had legs
in the first place because you refused
to address the significant, serious
deficiencies outlined in the four points
above. MARK. I KNOW I AM JUST A
MEMBER .... BUT I DO HAVE A RIGHT TO PUT A CSE TO THE BOARD AND ARGUE IT AS
HARD AS I CAN. THANKS FOR THE SUGGESTION, BUT I WASN'T PLANNING THE FEEL
DISINFRACISED OR ANYTHING LIKE THAT. I EVEN PLAN NOT TO DUMP ANY BALAST ON YOU
IF WE EVER MEET IN THE AIR.
> It is my contention that it is not
correct management to say that Accident
> and Incident Reporting should
not be done because we are too busy at the
> moment.
You've just
erected a straw man. Nobody has suggested that accident and
incident
reporting shouldn't be done. The argument has been that accident
and
incident *publication* shouldn't be done, because publication is
actively
harmful to the safety management culture you're trying to inspire.
IN ALL OF MY POSTS, WHEN I ARGUE FOR ACCIDENT AND
INCIDENT REPORTING I AM ARGUING FOR THAT REPORTING TO BE TO THE
MEMBERSHIP. I HAVE ALWAYS REALIZED THAT REPORTING WAS DONE
WITHIN THE ORGANIZTION ... GO BACK AND READ MY EARLIER POSTS.
What do
you have to say in response to that? How do you address the
four
points I"ve raised above? Or are you completely ignoring them
and
hoping that the change you want will go through anyway and damn
the
consequences? NO MARK. NOT IGNORING THEM. I JUST THINK YOU ARE WRONG
AND YOUR ARGUMENTS DON'T HAVE MERIT. APART FROM THAT, I THINK WE
HAVE CONCENSUS.
> There appears to be an underlying theme from
some who have posted on this
> thread that they have heard it all
before, all of these lessons are known, so
> why doesn't someone just
write a theoretical article or example about it.
> There are three
points I would like to respond to this:
>
> 1 A
real example is much more sobering and forceful than theory.
It
is? Why? If that's true, why has ATSB removed its accident reports
from
Flight Safety Australia? Can you name any other aviation
magazines across
the world which publish accident reports? Can you
name any other aviation
organization anywhere in the world which doesn't
have a formal accident
investigation capability but which publishes
accident reports anyway? THE HGFA, THE AUF/RAA. MY USA CONTACTS SAY THAT
THEIRS IS ALL FAA AND THEIR ,MEMBERS FEEL THAT THE REPORTS ARE
USEFUL.
> 2 As a relatively new pilot involved in
Cross-Country I want to know what
> real world mistakes others have made
and I want to be able to learn from
> those.
As a new pilot
involved in Cross Country, do you believe that you're
incapable of learning
about safety unless your lesson has blood dripping
from it? THAT IS
IMMOTIVE CLAP-TRAP. SEE RESPOSES ABOVE RE LESSONS TO BE LEARNT BY REAL WORLD
EXAMPLE FOR REAL WORLD PEOPLE.
I like to think that my fellow pilots
aren't so stupid that the only
lessons they can learn are the ones which
have killed or injured people.
Maybe you have a different view of your
peers; If so, please tell the
rest of us where you fly so that we can
avoid that part of the country. I HAVE NEVER ARGUED FOR THIS BEING THE ONLY
WAY TO LEARN ... SO WHO IS ERECTING A STRAW-MAN NOW.
>
3 It is clear that there are a number of experienced
Instructors who still
> make fundamental mistakes or allow their
students to make them, and I quote
> the couple of examples that are
used at the Safety Seminar ..... so even if
> those that have heard it
all before (and say that they don't need to hear it
> again) can, by way
of example, fly past a perfectly good runway in the
> circuit to get low
and land short/heavily damage an aircraft, newer members
> need to know
about this example and be aware that they too are likely to be
> tempted
to do the same at some time in their flying ..... and it obviously
>
won't hurt Instructors to hear it again either.
Do you believe
publication of accident reports in the magazine will solve
that problem? I
BELIEVE THAT IT WILL ASSIST. AGAIN I ASK WHY KEVIN'S SEMINARS ARE SO USEFUL?
ITS BECAUSE HE PRESENTS THEM IN A STRUCTURED WAY USING REAL EXAMPLES. AND THEY
HELP. AS WOULD THE SAME THING IN PRINT EACH MONTH, PARTICULARLY IF IT HAS HIS
OBSERVATIONS AND RECEMMENDATIONS AT THE END OF EACH REPORT (TO THE
MEMBERS).
If it doesn't solve that problem, how will you fix the
inevitable decline
in accident reports caused by the fact that those who
are embarrassed about
reporting their accidents will refuse to do so when
they know it's going to
get plastered all over the magazine? You'll
have reduced the efficacy of
the existing accident/incident reporting
system for no good reason, won't you? YOU SAY NO GOOD REASON. I DISAGREE. YOU
SAY THAT MEMBERS WILL STOP REPORTING. I DISAGREE.
> Re your 2nd
last paragraph, having attended the Safety Seminar in Wagga
> recently,
I wonder if the CTOO really does disagree .... and I say that if it
> is
worth travelling around the country to present those very worthwhile
>
Seminars, then it is certainly worthwhile reinforcing them in the
Magazine.
Perhaps you ought to ask the CTOO about that. He has an
email address,
and he has forthright opinions. He'll tell you exactly
what he thinks
about this if you ask him the question. He just
doesn't want to post
it to a mailing list (largely because dicussions on
mailing lists tend to
be inherently useless for providing any useful
real-world benefit to anyone,
as this one appears to have demonstrated) I
DID ASK HIM ............ SEE RESPONSE ABOVE.
> Mark said "Is there
-really- anything new to learn that we don't already know
> .....?" and
I say that the answer is a definite YES. Mark may not have
> anything
new that he needs to learn (how good would that be?), but I reckon
>
that every newer member, and every other member with less than say
20,000
> gliding hours, can learn a lot from well written real world
examples of where
> his/her peers have made mistakes.
... and are
those self-same pilots so dim that they can't learn from
non-real-world
examples? THOSE SELF-SAME PIOTS ARE NOT DIM AND SHOULD NOT BE KEPT IN THE
DARK. YES THEY CAN AND SHOULD CERTAINLY LEARN FROM THEORETICAL EXAMPLES
......... BUT WILL HAVE A TENDANCY TO SAY "I WOULD NEVER DO THAT". I CONTEND
THAT IT HAS MUCH MORE MEANING WHEN AN EXPERIENCED PILOT HAS MADE THE ERRORAND
I THEN HAVE TO ASK ... "WHY DID HE/SHE DO THAT AND WHY WON'T I IN THE SAME
CIRCUMSTANCES."
Ground them, I say. We don't need pilots like
that cluttering up the airspace
and presenting a risk to the rest of us.
I'M GLAD THAT YOU AREN'T THAT RISK TO THE "REST OF US".
> Taking the
example from the Safety Seminar, if you had asked the
> Instructor "Do
you need a refresher on circuit heights and procedures" before
> you fly
today, I would be sure he would have said something like "Is there
>
-really- anything new to learn that we don't already know .....?", yet
the
> fundamental accident still happened.
Which means that the
accidents *AREN'T* being caused by lack of knowledge. THERE IS NO ONE ANSWER
TO THIS, BUT OVERALL I CONTEND THAT IT IS NOT LACK OF KNOWLEDGE THAT IS THE
PROBLEM. IT IS MAINLY POOR PRACTICES AND AN EROSION OF STANDARDS THAT GET YOU
"SUCKED IN" TO BAD SITUATION. I ALSO BELIEVE THAT EGO & CONVIDENCE
GOES A LONG WAY TO ENCOURAGING A PILOT TO CHANCE HIS ARM ON SOME OCCASIONS,
BUT YOU WOU;DN'T HAVE A PROBLEM WITH EGO WOULD YOU?
In light of those
kinds of suggestions, I'm having difficulty understanding
why you think
publication of accident reports will make a difference. I HOPE THAT THE ABOVE
GOES SOME WAY TO EXPLAINING IT.
The pilots who have accidents *ALWAYS*
understand how not to have them.
Every pilot has been taught how to land
safely, taught how to avoid spins,
taught how to lock their canopies,
taught how to look-out, etc. THEN WHY DOES THE CTOO FEEL THE NEED TO UNDERTAKE
THE SAFETY SEMINARS
We're not dealing with a problem which is caused by
lack of knowledge,
lack of competence, or lack of awareness. The
causes run deeper than that.
And I think you're trying to apply an overly
simplistic solution to them. ALL i AM ADVOCATING IS ONE ARM OF THE OVERALL
SOLUTION. IT WILL NEVER BE TOTALLY SOLVED ............. BUT IT DOES NOTHING
NOT TO MAKE THIS VALUABLE DATA AVAILABLE.
-
mark
--------------------------------------------------------------------
I
tried an internal
modem,
[EMAIL PROTECTED]
but it hurt when I
walked.
Mark Newton
----- Voice: +61-4-1620-2223 ------------- Fax: +61-8-82231777
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