Ignored, denied, and swept under the rug
I talk a lot about the need for experimentation. All the management techniques intended to speed products to market involve some form of iteration, feedback and correction. Many suggest we should celebrate failure to counteract the unhealthy assumption that all failure can be avoided with planning,
The Boeing 737 Max has now demonstrated a disastrous failure of engineering and it is no cause for celebration. Lives have been lost, never mind the other costs to Boeing, the aviation industry and travellers.
Does this mean that Boeing should never try anything new? Does it mean that Boeing aircraft designers can never fail, ever? I don’t think so. What happened here was not a “fail fast” scenario. It was a classic slow failure, where the feedback a change provoked was ignored, denied, and swept under the rug.
The automatic trim Boeing introduced on the 737 MAX, called MCAS, was news to us last week. Graver, it was news to the Pilots flying the MAX since 18 months as well. Boeing and its oversight, the FAA, decided the Airlines and their Pilots had no need to know. The Lion Air accident can prove otherwise.
“Boeing’s automatic trim for the 737 MAX was not disclosed to the Pilots”
November 14, 2018, Leeham News
Boeing’s goal was to sell the 737 Max as a minor variation of an existing airframe – one that pilots would not need separate training for. Training pilots on MCAS, new to the 737 Max, would have been an admission that the plane was actually different to fly. This would have been a headache for the airlines – it’s cheaper to train pilots on a single type of aircraft. So the fiction was maintained that the Max and the original flew the same, with tragic results.
Better living through software
The 737 Max is a modification of the original 737, with its biggest improvement being larger, more efficient engines. Because the engines are slung under the wings, mounting the larger engines in the original location was not feasible as they would be scraping the runway on landing and takeoff. Instead, they mounted the engines slightly higher, and slightly forward of their original mounting locations.
If you spin a piece of paper across a desk, sometimes air will get under it and it will flip. High angles of attack cause the engines to generate lift. This lift, ahead of the wings, tends to rotate the plane’s nose upward, making what is already high angle of attack even higher. If not countered, this increasing angle of attack creates a stall condition, where the wings can no longer hold the plane aloft.
MCAS, or Maneuvering Characteristics Automation System, is a system intended to counteract this tendency by actively resisting pilot inputs that would result in a dangerously high pitch angle.
It turns out that not only was this system prone to error, pilots weren’t even advised of its existence and how to defeat it. The system over-corrected and drove two planes nose first into the ground.
So where does this fit in the innovation landscape?
I wanted to explore the MCAS failure as much of what is said about innovation is creating a culture that accepts failure. Is this the kind of failure we are willing to accept?
This wasn’t an innovation failure. This was an ethical one, where the effects of a change were hidden from view until they caused two disasters.
Photo credit
Steve Lynes from Sandshurst, United Kingdom – EGLF – Boeing 737 Max – N120IS, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=70921481
