Howard_2.3CaseStudy
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Uploaded by ChancellorGoatPerson27
Rian Howard
11/21/24
Victor Muchuruza
Boeing's Tale of Two Systems: Contrasting Approaches to Aerospace Engineering and Risk
Management
Background
The C-17 OBIGGS II Project was a significant initiative undertaken to improve the safety
of the fuel tank system in response to the potential threat of enemy gunfire. The project aimed to redesign the On-Board Inert Gas Generating System to address operational inefficiencies and safety concerns that were identified during its usage. The project involved a thorough analysis of the fuel tank system's performance and the identification of areas that needed improvement.
The redesign of the On-Board Inert Gas Generating System involved the installation of a new and improved system that utilized advanced technologies and engineering principles. The new system was designed to provide a more robust, reliable, and efficient solution that would enhance the overall safety and effectiveness of the aircraft. The project's successful implementation resulted in a significant improvement in the fuel tank system's stability, making it more capable of withstanding enemy gunfire.
The 737 MAX Development project was a remarkable initiative aimed at enhancing the competitiveness of the aircraft against Airbus's A320. The project involved major design changes, including the installation of larger engines, placed higher on the wings, to provide better
fuel efficiency. However, these design changes led to some aerodynamic instability issues, which
required further modifications to address. These modifications were implemented successfully, resulting in an aircraft that was safer, more efficient, and more effective in achieving its objectives.
Project Execution and Management
The tremendous success of the C-17 OBIGGS II project can be attributed to the exceptional collaboration and dedication of over 200 Boeing employees, 150 suppliers, and 50 Air Force members. The level of teamwork and stakeholder engagement achieved in this project is nothing short of remarkable.
The project team exhibited an outstanding level of proficiency in leveraging Air Force maintenance data to identify component failures, thereby showcasing their ability to efficiently use real-world operational data to solve problems. They also employed a variety of quality tools, such as Pareto analysis and brainstorming, to identify and resolve issues. These tools demonstrated their structured and comprehensive approach to quality management.
Thanks to the project team's efforts, the reliability of the C-17 OBIGGS II system has significantly improved. This has resulted in a remarkable reduction in maintenance requirements and an increase in operational efficiency, which has a positive impact on the overall effectiveness
of the system.
The Maneuvering Characteristics Augmentation System (MCAS) was introduced by Boeing in their 737 Max aircraft lineup to improve the handling of the planes with larger, more fuel-efficient engines. However, the implementation of the system was flawed and had some serious gaps in transparency, communication, and pilot training. These lapses led to two disastrous crashes - Lion Air Flight 610 and Ethiopian Airlines Flight 302 - and the grounding of the entire fleet worldwide.
The inadequate training and communication protocols for pilots and airlines meant that they were not fully informed about the MCAS (Maneuvering Characteristics Augmentation System) system's capabilities and limitations. This lack of knowledge and understanding of the system contributed to the two deadly crashes of the Boeing 737 MAX planes. The MCAS system
was developed in a hurry due to competition pressures, which led to insufficient testing and documentation. The system was designed to automatically push down the plane's nose in case of danger, but it was found to be faulty and prone to activating erroneously. The lack of proper testing and documentation meant that pilots were unaware of how to respond to the malfunctioning system, which ultimately resulted in the tragic crashes. Additionally, the MCAS system was not transparently integrated into the plane's autopilot system, making it difficult for pilots to diagnose and respond to the issues. These factors combined to create a catastrophic aviation crisis that could have been avoided had the proper training and communication protocols been in place, and had the MCAS system been thoroughly tested and documented.
The subsequent investigations revealed that the pilots were not adequately trained on how
to respond to the malfunctioning system. The lack of clear communication from Boeing about the system's design and operation also contributed to the confusion and ultimately to the fatal outcomes. The aviation industry has faced significant scrutiny and criticism in the aftermath of these
events, leading to a renewed focus on transparency, communication, and comprehensive training
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to ensure the safety of air travel. Boeing has been working on redesigning the MCAS system, incorporating multiple sensors and limiting its authority to prevent it from overreacting. The lessons learned from these tragedies have underscored the importance of collaboration, accountability, and continuous improvement in maintaining and enhancing aviation safety. The hope is that the industry will continue to prioritize safety above all else and that the future will be safer for all air travelers.
Risk Management and Safety Culture
The C-17 OBIGGS II system, being a critical component of the aircraft, was designed to ensure the safety of passengers and crew. Its proactive risk management approach is praiseworthy as it addressed known safety issues with utmost diligence. The system underwent rigorous testing and evaluation to ensure its reliability and effectiveness in mitigating the risks associated with On-Board Inert Gas Generation Systems (OBIGGS). Additionally, the incorporation of feedback from stakeholders, such as pilots and maintenance personnel, helped to
identify areas for improvement and enhance the system's overall safety features. As a result, the C-17 OBIGGS II system provides a robust safety net that inspires confidence and trust in the aviation industry.
The 737 MAX situation, where significant issues only received attention post-
catastrophe, is a clear example of reactive risk management. This approach is not ideal as it is reactive rather than proactive, and it highlights a gap in safety culture and proactive risk assessment. In such cases, risks are not identified and addressed beforehand, which can lead to catastrophic events. Hence, promoting a culture of proactive risk assessment and management is essential to avoid such situations in the future. Although the lessons learned from the Boeing 737
MAX disasters have been the theme of numerous government reports and investigative journalism, little has been discussed regarding metrics that could have provided early warnings of risk. It argues that the myriad failures that contributed to the crashes underscore serious systemic shortcomings in Boeing’s ability to manage risk. In addition to the organizational, cultural and technical failures, there was apparent negligence in the management of risk.
Lessons Learned
The C-17 project was a resounding success, thanks in part to the team's emphasis on comprehensive testing and using data to inform their decisions. This approach was in stark contrast to the development of MCAS, where a lack of thorough testing caused issues for 737 MAX. The importance of transparent communication and training for stakeholders was also highlighted in the case of 737 MAX, where these areas were found to be lacking. In contrast, the C-17 project team excelled in these areas. The divergent outcomes of these projects underscore the importance of corporate decision-making and prioritizing safety over market pressures, which can have a significant impact on project success and safety..
Conclusion
The Boeing case studies of the C-17 OBIGGS II and 737 MAX highlight critical aspects of aerospace engineering and risk management. While the C-17 project exemplifies a structured, data-driven approach with proactive risk management, the 737 MAX incidents illustrate the consequences of inadequate testing, poor stakeholder communication, and compromised safety due to market competition pressures. These cases serve as vital learning points for the aerospace industry, emphasizing the importance of safety culture, thorough testing, stakeholder involvement, and transparent communication in complex engineering projects.
References
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Johnston, P., & Harris, R. (2019). The Boeing 737 MAX Saga: Lessons for Software Organizations.
Software Quality Professional,
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Diss, K. (2022).
Boeing 737 MAX under scrutiny after multiple mid-air emergencies: The Boeing
737 is regarded as one of the world's safest and most widely used aircraft but faith in the manufacturer was rocked when Boeing introduced the updated 737 MAX. Two brand new planes dropped out of the sky, killing more than 300 people, and the new model was grounded worldwide
. Australian Broadcasting Corporation.
Thia, C. W., Chai, K., Bauly, J., & Yan, X. (2005). An exploratory study of the use of quality tools and techniques in product development.
The TQM Magazine,
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(5), 406-424. https://doi.org/10.1108/09544780510615924
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