Although the stakes were much higher and the eventual price was unimaginably tragic, NASA displayed many of the same barriers to learning caused by institutional norms for organizing and processing information as do many bureaucratic organizations.
NASA's decisionmaking process displays classic single-loop learning, in which it detected and corrected error (or failed to do so) in relation to an accepted set of operating norms. To engage in double-loop learning, NASA would have had to challenge the accepted operating norms and determine whether or not they were appropriate. This did not occur and, as a result, the operating norms of normalizing problems or anomalies, focusing on production, and structural secrecy continued to operate as barriers to learning.
Fragmented patterns of thought and action were rife in this case, causing different departments within the organization to operate with different views of the total picture of the situation. Since the engineering department was separated from the safety department, it was impossible for both departments to have a total view of the situation and, in this case, anomalies had to be deemed 'serious enough' by the engineering department to even be brought to the safety department's attention. This pattern of information-sharing (or lack thereof) could have the result of a disastrous malfunction that was never even brought to the safety department's attention. This is all too common of bureaucratic organizations, where a 'silo mentality' is common and departments tend to engage in protective 'turf wars.' Essential information can be obscured, be it intentionally or unintentionally, by these fragmented patterns of thought and action. Seriousness of problems can be obscured as a way of protecting self and colleagues.
Normalization of anomalies was another barrier to learning that served as a contributing factor. Small problems seemed to occur with every project, and the vast majority of time, production (launch) was achieved without a hitch. This created a culture where the organizational norm was to minimize anomalies unless, for some reason, they were deemed 'serious enough' to report upward. When this norm combined with the structural secrecy described above, the consequences could be disastrous. Even after a major disaster, the institutional memory of the disaster seemed to fade and any change in institutional norms seemed to fade over time, as the organization moved back to a familiar pattern with long-accepted institutional norms. The institutional structure remained complex, which contributed to continued fragmentation with regard to information sharing and decisionmaking. And focus on production by way of successful launches continued.
Even in organizations where barriers to learning might not have consequences as drastic as the Challenger and Columbia disasters, organizational norms guide information processing and decisionmaking at every turn. What are some instances where single loop thinking guided decisionmaking, and how did the institutional norms guide organizational decisionmaking? In the alternative, have you experienced situations where double loop thinking were accomplished and the organizational norms were evaluated for appropriateness?
NASA's Challenger and Colombia disasters are perfect, yet unfortunate incidents that are very vital in helping us get a tighter grasp on the mechanistic (bureaucratic), organismic and brain metaphors discussed in the previous chapter of the text "Images of Organization".
ReplyDeleteAs stated in the article, some of the major contributing factors to both the Challenger and Colombia disasters include a flawed decision making process that continually underestimated technical anomalies thereby normalizing it, a "can-do" attitude that pushes NASA to launch despite inadequate readiness and a structural secrecy that held back vital information from the bigger group.
Lack of proper channeling of information after the detection of a threat leads to the abnormal situation being eventually normalized. This normalization of errors as Katie rightly stated is a typical display of single loop learning. It differs from the principal theories in Cybernetics which emphasizes that organizational systems must be able to detect errors or threats, relate it to the existing organizational norms; deviating from these norms where necessary (double loop learning) and come up with the best solutions to that error.
The "can-do" attitude is a legendary slogan that NASA strives to uphold even during trying times. This is largely due to the "must launch" culture of production created by its own leaders internally, as well as NASA's institutional environment. In achieving a successful launch at all times, NASA has to conform to a lot of bureaucracy and hierarchy to the detriment of the entire space agency. Managers exert administrative powers over engineers, thereby giving less significance to their valuable technical observations and input. This highly mechanistic, hierarchical and rigid form of organizational administration is not the best operational system for NASA as it is a highly complex organization that can spell out a fatal disaster as in the case of the Challenger.The role of the environmental within which NASA operates cannot be overemphasized. As a government agency, NASA is not immune to Federal influences in key issues such as the maintenance of standards against all odds (political) and budget constraints. The latter is a fundamental necessity for NASA to operate.The importance of the government influence on NASA is an example of the organismic metaphor which places emphasis on the environment as much as the organization itself because the two are inextricably linked.
Finally the structural secrecy remains a major problem for not only NASA but many public organizations. The explicit rewards or consequences attached to success and failure continually affects our decisions especially during trying times. It is easier for one to sit on a critical piece of information than jeopardize one's work and position by bringing it up.
Today, many organizations grapple with these learning difficulties which vary from NASA's. Despite all the recommendations tabled by commissions of inquiry and consultancies, it is a common saying that old habits die hard. Due to this attitude, NASA soon became comfortable once again as time went by and therefore went back to adapting to pre-existing norms that have always governed them thus far. For effective learning, managers in organizations must be willing to step out of the comfort zone of norms and take up a double loop approach to organizational learning.
I think tha both of you make great points with regards to single and double loop learning. Too many tinmes we see this occur in all organizations, especially thos publicly run. I have heard so many times in my jobs of a "this is the way it has always been done" attitude. I think this is a case where NASA used to have double loop learning and fell back into a single loop learning method. This turned NASA back into the laid back attitude that allowed for mistakes and errors to be made. Another large issue that yo both point out is the way deadlines are pushed and this causes errors to be made. In the public sector, we see this frequently when people start complaining and we are instruted to cut corners in order to accomplish a goal. The result is a completed job that is done half hazardly. Unfortunately this is all too often the case. What do you think we can do to change this? Can PA do it on their own or is there too much political influence?
ReplyDeleteNASA’s decision-making process was flawed because they chose to adopt the can-do attitude, consistent with a desire to show they remained relevant in times when the White House and Congress threatened (or actually enacted) budget cuts. The cuts challenged operations, and I think their hope was if they could get the shuttle off successfully, they would receive a stabilization or even an increase in funding.
ReplyDeleteAccording to the article, the can-do attitude is actually what created an organizational culture that discouraged learning because of the structure. The engineers repeatedly attempted to bring problems up the chain of command, but eventually they stopped doing that and just did what they were told because no one listened. The fragmentation of tasks further complicated matters, as the engineers and safety team could not easily communicate about what they were finding. If they had set up a database or regularly met, even outside of work, similarly to how Xerox technicians helped that organization become a learning model, then a more holistic and diversified view of the situation would have been available. If that were the case, then perhaps normalization of failures would not have happened as much as it did, and with the penetration of the structural veil, shrouding departments in secrecy, then lives and jobs may have been saved. But because the can-do attitude was part of the corporate DNA and the teams were not diversified enough to take a holistic view. As Morgan (p. 110) puts it “If a team or unit is unable to recognize, absorb, and deal with the variations in its environment, it is unlikely to evolve and survive.”
History repeated itself with Columbia because the can-do attitude never left, and “the operating norms and rules of [the organization did not] change along with transformations in the wider environment.” (Morgan, p. 111).
What do you all make of the notion that Congress and the President have some blame? Could NASA have instituted the Xerox database idea in relation to the Shuttle? What would it look like?
I think Congress and the President should shoulder some part of the blame. They pushed the schedule and threatened budget cuts if the missions did not go as scheduled. This helped create the culture of moving forward and accepting the anomalies as standard process. However, if NASA administrator had told them there are anomalies that need to be investigated to guarantee crew safety and a successful launch, I can't see how Congress and the President would not accept it.
DeleteBill, i could not agree with you more. You hit the nail on the head and placed the shoes on the feet of those who walk all over the little people . The article stated on page 15 that "the White House and Congress must recognize their role in the decision and take responsibility for safety in the future."
DeleteThis is most certainly a top down hierarchical chain of command inside of NASA. Organizations that are federally funded by government grants are all most always forced to compromise, finagle, and/or cover up incidences and accidents (i have witnessed it on numerous occasions. Managers, leaders and other works often result to unethical means to reach certain goals and to acquire more money, prestige, accolades and an image of cleanliness and order. Most of this is due to a scarcity mentality and Charles Darwin attitude to some extend- the survival of the fittest.
Within this capitalistic society, greatness is not always who does the best job (especially buy taking ones time) but who finishes first by any means necessary.
Bill,
DeleteI agree that you have to put some blame on to the administration, but like you said, when do the administrators at NASA have to step up and say that it can not be done. People need to step up and take responsibility for their actions and what they are responsible for. NASA needed to step up and let the President and Congress know that they were not going to be ready for launch and they were cutting corners trying to do so. To many times people just do what they are told and do not think about their actions. It is okay to have dialogue and question their superiors. They are not all knowing and sometimes need to be put in check. That is the reason that are government is set up to have checks and balances. One person can not have too much power and people have the right to question their authority. This is what was not done in this case.
These posts make excellent points about the various factions that set competing and often conflicting priorities in organizations such as NASA. This is particularly common in agencies that rely on Presidential priorities and Congressional appropriations to ensure their continued viability and, often, their existence. The points made above not only speak to single-loop thinking and dysfunctional institutional norms but also to the 'brain-hand phenomenon' discussed previously as well as the political aspects that will be covered later in the course. In an organization like NASA, several 'brains' at the top are doing the thinking. These include not only the senior executives at NASA but also the President, his cabinet, and high-ranking Congressional members. These groups often have competing priorities and areas of focus due to the nature of their roles. Although the senior executives at NASA could very well be looking toward a long-range vision and would, were it entirely up to them, shift institutional norms away from many mentioned in the article, they face continuous pressure from 'brains' with limited tenure and short-range goals and visions. This creates a pressure to 'produce' by any means necessary which can lead to the information processing and decisionmaking that guides an organization into the single-loop thinking that controlled NASA.
DeleteNASA was setup in a way to almost prohibit double-loop learning.Vaughan stated (2005) "no ability to independently run tests that might challenge existing assessments". (p. 5). The lack of any kind of system, promoted going with the norm. In the case of both the Challenger and Columbia, the anomalies with the O-rings and foam were continuous problems. The reoccurrence of these anomalies made them the norm.
ReplyDeleteAs budgets were cut, the safety division was cut the most. This was the main area in charge of reviewing the anomalies to determine if it were safe to launch. The cuts made it difficult to follow through. There was also a culture in NASA to make sure the launch went off on schedule. This made employees not want to speak out and question why the anomalies were occurring. If one were to question things delaying the mission, they may be the next budget cut.
After the Challenger disaster things got better for awhile, until people started getting comfortable again. They then fell back into the old routine and bad habits. The Columbia disaster made me think of cybernetics. NASA started out on the right foot and swung worse and worse until the point of the Challenger disaster. After Challenger, NASA swung back the other direction, until they got comfortable again and started back down the road of relaxing. They continued this way until finding the point of disaster again. After Columbia, NASA again swung the other direction. The back and forth pattern is what cybernetics is all about. Are these the only two disasters NASA will have on its way to find the correct point, or will it continue its swinging back and forth?
So how can they restructure NASA to encourage double loop? How can they challenge operating norms in this context? It seems like the best way to go would be to adopt safety first attitude, not can do. And there cannot be a split between the right and left hands
ReplyDeleteUnder the topic of Natural Selection: The Population Ecology View of Organization Morgan includes a perspective that is very befitting to this Challeger essay/situation. He writes, “ [...] in critiquing the “adaptation” view of organization, the population ecologists have highlighted the importance of inertial pressures that often prevent organizations from changing in response to their environments. Specialization of production plants and personnel, established ideas and
ReplyDelete‘mindsets of top managers, inadequate information, the difficulty of restructuring, technology and personnel in unionized plants, the force of traditional, barriers, to entry created by legal, fiscal, and other circumstances, and many other factors make it impossible for organizations to engage in timely and efficient changes.” (page 60-61).
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ReplyDeleteI am not sure why the writing spaced as it did above... sorry
Delete(Opener"?")
DeleteSingle Loop thinking/learning guided decision-making allowed those in authority to usurp others decision making power. The cost were irreplaceable. The trade off of moving forward rapidly caused sacrifices that outweighed the risks due to “normalization of anomalies” as others have indicated. The cliches of “safe first” or “better safe than sorry” may have been foreign words to upper administrators. It makes me wonder and question what kind of training does the staff/workers endure. Can NASA learn something from FEDX as far as their mode of operation?
It appears also management didn't want to spend time or money up front which is a repeated cultural error that i can not understand why it is not seen and utilize. It seems it would have been easier and cost less time and money to replace the o-ring when they “first” realize it was an issue which could pose a bigger threat later. In the end losing the entire Challenger and human lives was the outcome.
An article that i found on line expressed single-Loop Model in this way. "It was hypothesized that human behavior, in any situation, represents the most satisfactory solution people can find consistent with their governing values or variables, such as achieving a purpose as others define it, winning, suppressing negative feelings, and emphasizing rationality.367/ASQ (http://academic.udayton.edu/richardghere/igo%20ngo%20research/argyris.pdf)."
This tells me that the "think-tanks" who were in author had a certain set of values that appear inhumane. Did the decision makers feel any sense of remorse to their error and even more to the death of astronauts during the process or even after the process or were they more of a machine minded desensitized begin trapped in the matrix of business as usual?
Kate also posed the question “In the alternative, have you experienced situations where double loop thinking were accomplished and the organizational norms were evaluated for appropriateness?” Yes. It was not necessarily an organizational setting but i experience double loop thinking/learning which the outcome was good. Several years ago at Lincoln Land Community College i took a Composition Class from Maureen Emonds. She had been an instructor there for several years. She had her classes due a particular writing assignment the same way the entire time (maybe 5-7 years). The assignment was to look on her list of 15 eras in ancient and past history. Examine the time lines. Write about why you would have wanted to live during that time. What were the great things of which you would have like to be a part? Some of these eras listed from what i recall were, Roman Era, World War I/II, Reconstruction, and things like this. Every era listed was a time when women had little to no say and Black people whom i called Americanized Africans, had no say and no identity. I looked at the assignment again and again as i sat in class in 2005 when there were still very few African American and even few at my age (there were many young people there). I realized, there was not one era listed in which “I” would have wanted to live listed.
ReplyDeleteAfter class i approached Mrs Emmons. I calmly, rationally, and sincerely express the above explaining that it is only recently that “we” (African American and women) have had more opportunities, rights and a voice. She looked amazed. She said not one student in all those years ever express that to her. She said she never meant to be insensitive but it had not occurred to her that this could in fact be the case. She said as a blond haired blue eye psychology major she could identify with what i was saying because people had thought of her as a blond bim-boe. She would then allow me to write about an era in which African American flourished and were openly able to express himself. SHe introduced me to the 1920 and the Harlem Renaissance. I have never heard of it. All i knew were the traditional Dr King, Frederick Douglas, Carter G Woodson and Harriett Tubman stores. I did not know of this rich history and outpouring of art, poetry and music. At least up until the Crash of 1929.
By allowing me to challenge her normal way of thinking we both were able to grow and learn. This was a great balance and a demonstration of how to capture knowledge without killing it. In fact, through that discovery my self-esteem rose to a great level and I actually cut the perm from my hair and start my dread loc and changed my diet. I decided to look at life, education and business in a bold new way. Young people may have been thinking go with the flow. I, on the other hand had shown up to learn. Even today i feel like “I” am paying $20-$40,000 for this meal(education) i want it to be beneficial to my brain and my body AND i would like to be able to share it with others. But, education doesn't really work like this does it? It is a lunch buffet during the middle of the day where we scarf down things we seem to like and get back to business as usual. THe outcome- what we put into our body is what comes out. What we put into our brains and the way we process it or are trained to process it will what comes out. I prefer organic over mechanically processed things.
Unfortunately, we are often force to color inside the lines which i understand is essential to certain operational functions otherwise there would be a serious imbalance. With that said as we use the brain metaphor we can understand that many mental illness that affect the body and the action people make are from a chemical imbalance in the brain. There is no clear balance of left and right hemisphere. When it come to the single minded unbalance gatekeepers and decision makers of public education the imbalance is detrimental. As we can see, the impact on education in grades K-12 is apparent and evident, particularly in the inner city. ANd thus the expansion of privatization for more incarceration. Rather than take the time and money to teach, learn, share information and decisions and understand how to better educate, the top would rather allocate resources to NASA, the military, and the criminal justice systems while closing the doors of 52 schools. The agenda is to maintain and widen the pipeline to prison. The disaster will result in the same as the challenge- a broken irreparable vehicle (education system) and the death of our youth. But that is another subject… sorry, I almost went into a whole new direction of explaining single minded machine, Darwinist leadership vs triple minded (tri-unity), one body organismic thinking. I prefer double loop learning from what i understand so far but i realize that triple loop learning should be incorporated.
DeleteHere is an interesting document on triple loop learning: http://ptarpp2.uitm.edu.my/silibus/circorg.pdf
Bottom line as with anything is BALANCE, time management and values.
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ReplyDeleteKatie you are right on with your summary of the barriers to learning created by NASA's organizing and processing its information. As an agency, NASA struggled to define itself during this period. NASA didn't have a consistent institutional identity in regards to how it would approach utilizing its organizational information. At times, NASA was more technical in its approach and agency values reflected this approach. Innovation was valued over processes, each shuttle project was considered experimental, not operational and structural secrecy was minimized due to the technical emphasis of empirical evidence and objectivity being valued over political selectivity. This placed the scientific method at the center of how decisions are made with regards utilizing information, allocating limited resources, fitting the right person to perform the job and monitoring performance and procedures associated with that job.
ReplyDeleteNASA also operated as a bureaucrat organization at times as well. Processes was valued over innovation, loyalty to the hierarchical structure was emphasized and accepted as operational norms and an importance was placed on outcomes which followed all prescribed operational processes listed in the Agency manual as opposed to the outcome itself.
The Agency also operated as a pseudo-learning organization which adopted to its political environment. They experienced reductions in their operational budget however programmatically the shuttle launches continued. A public-private partnership was established to offset the loss of institutional knowledge and expertise in the areas NASA was negatively impacted by staff retirements and agency transfers after the Challenger o-ring malfunction.
Most telling about the organizational schizophrenia NASA encountered was the impact of external factors on what type of organization NASA became during this period. Political policy initiatives, budget reductions, and public-private partnerships had an enormous impact on the Agency's managerial approach toward dealing with information and people. Management developed a dogmatic leadership style which actually splintered the "steward" leadership model. The attitude of "can do" and the "mission of the organization" became greater than the consequences of the decisions made. Elizabeth Graffy, in her commentary titled, "Frameworks, Practices, Mentors, Norms: What Shapes Public Managers" questions the roles of public managers in the governmental process. Ms. Graffy critiques Durant and Ali's, "Reposition American Public Administration? Citizen Estrangement, Administrative Reform and the Disarticulated State", by stating public managers are more than policy implementers, similar to train conductors without an interest in the train. She submits managers are policy innovators with an impact on the environment we operate in. As public managers, this is the larger lesson that can be taken from this case study.
Hey group i apologize. I am tying to switch over and post Google docs into the blogger. I notice that some were using it. I like the fact that it saves as you are typing and adds other features (which i am still learning) so excuse me for the multiple similar posts.
ReplyDeleteGrade: 20 Points
ReplyDeleteGreat discussion, I hope you all can see the value of the brains metaphor for organizations (the concept of organizational learning - learning organizations) as a tool in the toolkit.
Several important questions to think about: How does individual/group learning become organizational? What does a supportive learning environment look like? What mechanisms or processes can support learning at three levels: individual, group, and organizational? How can organizational leadership reinforce learning at all three levels?
Do you see any of the dysfunctional behaviors of NASA in your own organizations? Keep this case in mind as we move into the culture and political metaphors.