Back when Rear Adm. Frederick Luchtman was a Landing Safety Officer on a carrier — keeping an eye on whether pilots were on their 3.5-degree glide plane and sticking to the approach centerline — he was a key player in a learning process he now aims to introduce Navy-wide.
As commanding officer of the Navy’s 7-decade-old, Norfolk-based safety operation — just upgraded to a command directly reporting to the Chief of Naval Operations — Luchtman leads the new safety initiative.
It’s about a mindset and process he knew as an aviator and then as an LSO.
“The first question is compliance, black and white, yes or no, The second question — and that is 90% of it — is asking ‘Why?’” he said.
When the experts from the Naval Safety Command visit a ship, watch flight operations or stop by an onshore facility and see something amiss, their aim is much the same as Luchtman’s when he was an LSO watching his fellow aviators landing on their carrier. Once all the planes had landed, his job was to go to the ready room and debrief each pilot on what went right — and what didn’t — and get everyone thinking about how to improve.
Assessing what sailors and Marines ordinarily do and asking why they do things a certain way when not complying with standard procedures starts a process that is subtly different, but a significant shift from the way safety agencies have long operated: analyzing accidents after the fact, finding a cause and publishing recommendations to avoid repeats.
“We’re looking at behavior,” Luchtman said. “We want to see things like what kind of review do you have after a near-miss ... if you look at what they do as they do their routines, we can apply that to a variety of tasks they do.”
So, experts from the command might not get a chance to see the crew handle the risky task of taking on supplies and fuel while their ship and a supply vessel are in motion, but watching the deck division or bridge team handling other tasks can signal a mindset and attention to detail that promises to make underway replenishment go smoothly — as most do.
The command also is in charge of the Navy and Marine Corps’ Safety Management System, responsible for enhancements to better relate findings from different units to one another to look for broad trends and risk factors, and to improve and broaden communication of those findings to the right places for action — whether that’s the CNO, the commanders of fleets or strike groups, or department heads and deckplate leaders on ships.
Computer models developed by the command to look in detail at the experience of any unit’s personnel as well as recent turnover in tandem with data about how busy they are and how quickly they’re asked to take on new challenges, can signal when a ship or Marine unit might be more vulnerable to safety failures or slip-ups.
The command has tested the models by seeing if they could have warned of past situations that set the groundwork for accidents. They did. And they can help those ships or units take steps they might need to — training, bringing on more people, maybe tweaking operating schedules — to mitigate the risk, Luchtman said.
“We want to move from the right side of bang to the left of the bang, to be preventing it,” he said, using the common Navy left-right language to describe when actions happen earlier — to the left — or later.
Upgrading the safety center, now command, is a key element of Chief of Naval Operation Mike Gilday’s “get real, get better” initiative, sparked in part by concern over a series of fires and ship collisions in recent years.
“There’s too much of a variance across the Navy between those commands that do exceptionally well and those commands that struggle and then make big mistakes — whether it be a collision, whether it be a fire, whether it be a fuel spill,” Gilday said on a recent visit to Hampton Roads.
“We will do safety assessments at a deeper level across the Navy. So down at the ship level, the squadron level, the submarine level. And this is part of that self-assess, self-correct kind of behavior that I want to institute more robustly and more fully in the Navy,” he said.
“We’re kind of the pointy tip of get real, get better,” Luchtman said.
And ultimately, the mission is about people — a focus that came home to Luchtman on his assignment immediately before moving to the safety command.
He headed up the Navy’s “physiological episode” investigation, looking into reports that pilots were suffering from hypoxia — too little oxygen.
“We saw P.E. drop 95%,” he said. “The point is, I started off convinced it was a problem with a mechanism, but it wasn’t until I started asking about the human factor that we really identified the issue.”
What he found was that dehydration, stress, poor sleep, poorly fitting flight suits, often in combination, were factors in the illnesses pilots reported. Knowing that, a fix was possible.
“You know, no sailor or Marine goes to work thinking: ‘today I’m going to hurt myself,’” Luchtman said, “We owe it to them to provide the training and assessments so they can keep themselves safe ... so they can go home to their families at night.”
Dave Ress, 757-247-4535, [email protected]
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