The Magnificent Seven
By Richard Komarniski
June 1999
Richard Komarniski is President of Grey Owl Aviation Consultants. He has worked as an Aircraft Maintenance Technician for the last twenty-three years holding AME and A&P Ratings. Richard has been providing Human Factors Training to various aviation maintenance departments. For information on Human Factors training or assistance in setting up a MRM Program contact Grey Owl Aviation Consultants, Box 233, Onanole, Manitoba ROJ 1NO Canada, telephone (204) 848-7353, or fax (204) 848-4605, www.greyowl.com or [email protected].
With the conception of the Dirty Dozen in 1993, the twelve poster series was published in 1995 with funding from the aviation industry and was designed to represent the twelve most common causes of human error in the aviation maintenance industry. The Dirty Dozen posters were conceived and developed by an industry organization spearheaded by Gordon Dupont. Now, available from MARSS (Maintenance and Ramp Safety Society), these posters have been distributed worldwide and translated into many languages. Numerous airlines, repair stations, and training organizations have based their human factors awareness training on the Dirty Dozen. Frequently, after a human factors workshop is provided to an organization, the Dirty Dozen posters are displayed in work areas as visible reminders to the work force.
A new set of posters called "The Magnificent Seven" has been developed and is the basis for follow-up training to the original workshop. These posters focus on positive actions that every employee can take and also place an emphasis on professionalism within the aviation maintenance community. The Magnificent Seven posters are drawn by the crafty hand of world-renowned aviation artist, Fran?ois Bougie of Bizart Image and are issued to remind us of our professional role in this industry. The Magnificent Seven posters are described in the following paragraphs.
1. Safety is not a game because the price of losing is too high.
Company mission statements may include words such as "Worlds Best," "Reliable and Affordable Air Travel," "To provide the industry with an airworthy aircraft that is safe and comfortable to our passengers, on time," and "Safety #1, Customer #2, Economics #3 are the priorities of our job as technicians." When safety, quality, and customer service are company priorities, history has shown that these companies are able to withstand the competition and economic pressures. Avoid falling into the trap of "If you do not have time to do things right the first time around, you always have time the second time around, if you get the chance."
2. Our Signature is our word and more precious than gold.
We provide the industry with safe and reliable aircraft. Our integrity is reflected everyday, everytime we sign our name. Once the work has been completed, the documentation has been done indicating everything has been accomplished to meet the airworthiness requirements, we know the work has been completed to the best of our capabilities. When we take pride in our signature, we can go home after a long and hard, midnight shift and have an undisturbed day's sleep without worrying about the tasks we completed that evening.
3. We all do our part to prevent Murphy from hitting the jackpot.
When we consider Reason's Model of Error Analysis and look at everyone's role in preventing errors, we can see that when a company has an incident, there is a chain of events established identifying the contributing factors and the causes of the incident. We find that there were latent failures in the regulations, management, policies, and company culture. Then, there are active failures from direct supervision, scheduling, use of resources, time management, and communication. And then, there are other active failures, like the Dirty Dozen, that influenced the judgment of the technician, which lead to an error.
4. We always work with a Safety Net.
Safety nets are the precautions or counter measures we take in our day to day lives to prevent the latent errors and human factors from effecting our judgment. The safety nets are the precautions we take to bring us back to reality when we become overly emotional during the last task we just completed. Safety nets we all use include dual inspections, using checksheets, taking pride in our signature, making notes as to where we left off, staying fit and vigilant, using the manual, and the list goes on and on. We all have our own countermeasures. Continue to use and review your safety nets to make them even better. We need to make sure we have a tight net protecting us, with no holes in it.
5. We are all part of the team.
The last place I worked was fantastic. The whole organization worked together. It was a freight and passenger charter operation with 150 employees. The place ran like a Swiss clock. Dispatch did a great job at organizing flights and dealing with customers. Flight crews did a fantastic job at operating the aircraft and communicating with dispatch, maintenance, management and customers. The Cargo department did their best to not destroy the payload and the aircraft interior. And of course, maintenance did their job every night to maintain the aircraft to provide the reliability expected by dispatch, flight crews, cargo department, management, and customers.
This just did not happen by mistake. There was a lot of communication that took place between all of the departments. Because of the communication, morale was high and the error rate was very low. As we all know, without teamwork, there is a lot of waste and error rates are high.
6. We work to accentuate the positive and eliminate the negative.
We all hate to see errors take place for the obvious reason. But, if we have an error take place without learning from it, then it will most likely happen again in the future. No matter what happens to us in our lives, there usually is something positive to be learned or gained. We should learn from our mistakes and share these experiences with others so that they do not make the same errors. At the moment it can be the worst thing that can happen to us, but if we look at the positive and learn and grow from the event, we will be a better human being.
7. Just for today - Zero Error
When we look at error prevention and at the big picture, it can be quite overwhelming. Break error prevention into little steps and we can make giant strides in reducing errors. Like anything else worthwhile, if we take the steps necessary to prevent errors one day at a time, it will not be an insurmountable challenge.
There you go folks, "The Magnificent Seven." Writing about them is just as exciting as using them in a follow-up workshop to the Dirty Dozen. We all have a great future ahead of us if we have the right attitude. "Attitude is everything and you are in control of your attitude!"
