Boeing Board Aerospace Safety Committee recommends realignment, enhancement of procedures

Admiral Edmund Giambastiani (Ret). Photo credit: Wetheitalians.com

Sept. 25, 2019, © Leeham News: Boeing today outlined the results of the investigation of a special Board of Directors committee formed in August that creates new processes and organizational structures aimed at preventing another 737 MAX crisis and improving safety within Boeing Commercial Airplanes.

The Board-level Aerospace Safety Committee is the four-member committee announced by Boeing CEO Dennis Muilenburg following the second fatal accident of the MAX in March.

Admiral Edmund Giambastiani (Ret), a former nuclear submarine officer, chaired the committee. As a result of the committee’s work, the following recommendations have been made:

  • Create a Product and Services Safety Organization;
  • Realign the Engineering Function;
  • Establish a Design Requirements Program;
  • Enhance the Continued Operation Safety Program;
  • Re-examine flight deck design and operation; and
  • Expand the role and reach of the Safety Promotion Center.

Outside experts

The Board committee of four is outlined in the Boeing press release below, which is reprinted in its entirety. The committee retained a group of outside experts to assist in its probe of BCA’s safety processes on the MAX.

Among these experts tapped by the committee were:

  • Sean O’Keefe, former NASA administration and head of the Columbia space shuttle accident investigation. O’Keefe was also CEO of EADS North America, at the time the parent of Airbus North America;
  • Richard Stanley, a retired engineer and VP of GE Aviation;
  • John Tracey, retired SVP chief engineer for Boeing;
  • Kirk Donald, director of the Navy nuclear propulsion program;
  • Skip Bowman, another nuclear program expert, who participated in the BP safety review panel after the Deep Water Horizon oil rig disaster; and
  • David Dunaway, former commander of Naval Air Systems procurement, testing and evaluation.

“We spent a huge amount of time from April for this five month review,” Giambastiani said.

Access and mandate

Giambastiani said that the committee had full access to BCA. It also looked at the processes of the 777X, which is in ground testing in advance of the delayed flight test program. Engines provided by GE Aviation had flaws in them that prevented the flight testing from beginning. Boeing hopes to proceed to flight testing by year-end.

There was “nothing off the table” in the committee’s probe, Giambastiani said. “We were specifically not assigned the task of investigating the Lion Air and Ethiopian 737 MAX accidents…due to all the ongoing formal investigations.”

The committee was assigned the task of reviewing policies and processes “that were in place for the design and development of the airplanes to ensure safety, and further, our committee was assigned the task of recommending any changes or improvements…to those policies and procedures,” Giambastiani said. “Hardening and strengthening were a very important component of what we were doing.”

What was examined

Giambastiani  said BCA engineering reviews included airplane certification foundation; FAA organization; Boeing certification and Organization Delegation Authorization (ODA); jet airplane accident annual report; certification of the 777X and certification of the 737 MAX to see what differences there were between the two programs; pilot qualification training by the FAA and international regulators; and all the gated engineering processes.

The committee also looked at design requirements; flight sciences, system design, hazard categories, probabilistic failure analysis propulsion design, airplane level validation and verification; simulator sessions; pilot training strategy; and quite a bit more.

ODA is the FAA-designate within Boeing. Gated engineering are milestones of any 7-Series airplane development program.

We looked at strengthening engineering to reduce enterprise level risk,” Giambastiani said.

Findings

The Board committee concluded a number of processes can be improved, “hardened” and “strengthened,” Giambastiani said. These are outlined below in the press release.

“All of these recommendations have been acted upon, with a rolling implementation,” Giambastiani said.

But in response to a question from LNA, Giambastiani didn’t provide detail about how these are being implement nor over what period of time or how the certification process of the MAX 7, MAX 10 and 777X might be affected by these changes.

Giambastiani said that the Board committee found “categorically” that all the FAA standards, protocols, policies, processes and engineering functions were followed.

The committee found no competing interests that would have compromised the safety of the MAX, Giambastiani said.

Boeing Press Release:

The board formally approved the creation of the new Aerospace Safety Committee at its August 2019 meeting. The committee’s primary responsibility is to oversee and ensure the safe design, development, manufacture, production, operation, maintenance and delivery of the company’s aerospace products and services.

Adm. Edmund Giambastiani, Jr., (Ret.), former vice chairman, U.S. Joint Chiefs of Staff, and a career nuclear-trained submarine officer, was appointed chairman of the Aerospace Safety Committee. The board also appointed to the committee current Boeing Board members Lynn Good, chairman, president and CEO, Duke Energy Corporation, and Lawrence Kellner, president, Emerald Creek Group and former chairman and CEO of Continental Airlines. These board members each have extensive experience leading companies and organizations in regulated industries and government entities where safety is paramount.

Separately, the board amended the company’s Governance Principles to include safety-related experience as one of the criteria it will consider in choosing future directors.

The board also announced today its recommendations from the five-month independent review of the company’s policies and processes for airplane design and development by the Committee on Airplane Policies and Processes, formed in April 2019 following the Lion Air Flight 610 and Ethiopian Airlines Flight 302 737 MAX accidents. Reaffirming Boeing’s commitment to the safety of the global aerospace ecosystem and to the safety of its products and services, the board recommends that the company:

  • Create a Product and Services Safety organization: The board recommends that a new Product and Services Safety organization be created and report directly to senior company leadership and the board’s Aerospace Safety Committee. The organization’s responsibilities would include reviewing all aspects of product safety, including investigating cases of undue pressure and anonymous product and service safety concerns raised by employees. The organization also would maintain oversight of the company’s Accident Investigation Team and the company’s safety review boards. The committee believes the work of this organization should increase awareness and reporting of, and accountability for, safety issues within the company, further improving enterprise-wide product and services safety.

It is recommended that the enterprise Organization Delegation Authority, the company’s engineering and technical experts who represent the Federal Aviation Administration in airplane certification activities, report to the Product and Services Safety organization and vice president for Product and Services Safety.

The board further recommends that the Accident Investigation Team as well as the teams responsible for military aircraft certification and mission assurance for space and launch systems report to the vice president for Product and Services Safety.

  • Realign the Engineering function: The board recommends that engineers throughout Boeing, including the new Product and Services Safety organization, report directly to the chief engineer, who in turn reports directly to the company’s chief executive officer. The company’s chief engineer should focus his or her attention primarily on the Engineering function and the related needs of the company, supported by a senior leader who is responsible for developing, implementing and integrating new technology, tools, processes and digital systems. The board believes the recommended realignment would strengthen the company’s Engineering function, promote continued companywide focus on customer, business unit and operational priorities, and result in an even greater emphasis on safety.
  • Establish a Design Requirements Program: The board recommends that the realigned Engineering function create a formal Design Requirements Program that would incorporate historical design materials, data and information, best practices, lessons learned and detailed after-action reports. The board believes this will reinforce Boeing’s commitment to continuous improvement and a culture of learning and innovation.
  • Enhance the Continued Operation Safety Program: The board recommends that the company amend its Continued Operation Safety Program to require all safety and potential safety reports be provided to the chief engineer for his or her review. This requirement would increase transparency and ensure safety reports from all levels of the company are reviewed by senior management.
  • Re-examine flight deck design and operation: The board recommends that Boeing partner with its airline customers and others in the industry to re-examine assumptions around flight deck design and operation. Design assumptions have evolved over time, and the company should ensure flight deck designs continue to anticipate the needs of the changing demographics and future pilot populations. Additionally, the company should work with all aviation stakeholders to advise and recommend general pilot training, methods and curricula – where warranted, above and beyond those recommended in a traditional training program – for all commercial aircraft manufactured by the company.
  • Expand the role and reach of the Safety Promotion Center: The board recommends that the Safety Promotion Center’s role and reach be extended beyond Boeing’s engineering and manufacturing communities to the company’s global network of employees, factories, facilities and offices. This expansion would serve to reinforce Boeing’s longstanding safety culture and remind employees and the flying public of the company’s unyielding commitment to safety, quality and integrity.

 

 

112 Comments on “Boeing Board Aerospace Safety Committee recommends realignment, enhancement of procedures

  1. An impressive cadre of experts were tapped by the committee. I particularly like the extensive experience in the Navy nuclear propulsion program, which has a very strong safety record and robust safety culture. A fresh set of non-aerospace eyes to review Boeing’s processes.

    • Oh dear,

      I don’t know where to start. I think Mike Bohnet’s words address the issue:

      “An impressive cadre of experts were tapped by the committe”

      Putting together a committe to back Boeing isn’t impressive. It’s doesn’t work. It’s been done before.

      It really saddens me what is happening to Boeing. I’ve said Boeing need to do a Rolls-Royce. The CEO at Rolls-Royce was replaced and the new CEO is clearing out the rubblish. It’s ruthless and brutal. But necessary.

      What’s going on at Boeing. Boeing’s CEO appoints a committe. The committe support him. There’s a surprise, I say sarcastically.

      Seriously, dear me.

      With regard to the MAX crashes we are seeing rumours in the press. One side says it’s design faults and lack of oversight meaning Boeing and the FAA are at fault. The other side says maintenance and pilot skills are at fault meaning the airline’s maintenance, pilots and their training arecat fault.

      As I said before, it’s going to get nasty. But, Boeing have their impressive committe to support them. I’m so impressed, I say sacastically.

      Design faults and lack of oversight for me!

      • @Philip: I personally know Sean O’Keefe and can vouch for his independence and integrity. I will point out (as I did in the article), O’Keefe was also CEO of EADS Americas.

        I don’t know any of the others, but I did know another nuclear submarine Admiral and he was forthright and independent. If these Admirals are anything like him, they, too, wouldn’t pull punches.

        • If your words were true the committee would have said to Boeing’s board of directors go and go today.

          Boeing are in desperate need of new blood.

        • Nice to see Boeing throw $$$ at a couple ex-GE and ex-McDonnell Douglas executives. Are there any doubts about what company cultures dominate Boeing today? Perhaps that is part of the problem.

      • I don’t think Rolls-Royce is the shining example that Boeing should aspire to.

        • Philip may well be surprised but I agree with him.

          While I do not personally know Sean O Keafe, what I have seen of him in his public persona was not positive (EADS head or now)

          While Rickover was indeed a terror, he also was a monstrous prim donna which tends to most Admirals and Generals who are 95% political if you follow the results of their careers when the hard stuff begins. In one case with Rickover he told a supplicant Sub commander to do something o piss him off. Said Sub commander complied by sweeping his desk clear and Rickover went livid.

          To know if this was effective we have to know how each one conducts his public business and the integrity there in.

          If I was doing this with intent to correct, I would pick a single individuals with an impeccable l record
          1. Diane Vaughan who saved me in my hours of confusion.
          2. Carl Barbier: Who did what I believe was the most brilliant job of assessment of failure I have ever read.

          I see nothing such as Boeing’s FAA designated inspectors reporting to the FAA like they used to – that alone tells me it was nothing more than CYA.

          • Having AR’s report directly to the FAA like before is not something that Boeing can just do whenever it wants. The decision belongs to the FAA and the director recently said that going back in that direction would require an additional 10,000 employee’s. Not a decision Boeing can make.

            What does Rickover have to do with the discussion? All the Navy Nukes I know, and I know several of them, tell me pretty much the same thing about the safety culture, and the Navy’s nuclear operational safety record speaks for itself. From what I’ve learned from them, I highly doubt that Skip Bowman or Kirk Donald would rubber stamp anything for Boeing.

          • Scott brought up the nuke program. I am pointing out that it was not all love and roses.

            If you do not follow the military, the higher you go the more political you are to the point its all political.

            Any one with integrity is washed out at the first General level or first Admiral level. Those who reach the top go to work for companies like Boeing.

            Tell me that the CEO” of Duke Energy with their massive coal plants and slag dumps is someone you admire?

            “Mr. Giambastiani, who is a former vice chairman of the U.S. Joint Chiefs of Staff, will lead the new safety committee. Other members will include Duke Energy Corp. Chief Executive Lynn Good ”

            Yep, Lynn is just the person I want involved in a safety committee.

            Giambastiaini former VC of the US JCFS, yep, he is all about safety.

          • TransWorld,

            Any one with integrity is washed out at the first General level or first Admiral level. Those who reach the top go to work for companies like Boeing.

            As someone who’s briefed and done demos for general officers of all levels, it is easy to see that your characterization is based on ignorance and prejudice.

            Also, not sure why you think I admire the CEO of Duke Energy. I only ever talked about how I think the Navy Nukes bring extensive and measurable safety related experience to the committee.

          • Mike B:

            As someone who has watched the militray mucky mucks live in their ivory towers and take jobs in industry afterwards, I call it reality based assessment.

            And you live with those you associate with, so anyone that is on a board with Duke Energy shares the same morales or lack there of.

            You may have sunshine in your eyes but I have watched the system for far too many years to think its other than corrupt.

            Does the name Patreas resonate at all? Fat Leonard? Black Hawks shot down over Iraq and the attempt to blames a lowly Lieutenant a9and the DOD failure to provide the poll to congress?) AWAC take down by a goose flock and blaming a Sergeant with 20 other duties, no funds and the goose control last on his priority list? Nuclear weapons flying around free? Nuclear weapons triggers to Taiwan (thank you so much fore sending them back)

            I have yet to see an incident of any closely analogous type where the commanding admiral or general step forward and said I am the one responsible for this.

            Tell me the aides did not see it and know what was going on and said nothing!

            Much like Muelengberg, if you get caught you hope you can blame it on someone else.

          • TransWorld,

            And you live with those you associate with, so anyone that is on a board with Duke Energy shares the same morales or lack there of.

            So, you’re fine with guilt by association?

        • @Mike Bohnet

          Rolls-Royce have had problems. But they have built trust by addressing them properly.

          The technology coming through will mean they will star in the coming years. Neither GE or PW can match the technology. The foundations are being laid now.

          But you are allowed your opinion.

          • I would disagree RR has built any trust at all.

            The recent failure on an engine that should have been fully safe (Norwegian over Rome) is the case in point.

            Each time RR has stated we know the issue and have it assessed and know that the safe limits are they have been wrong.

            A troubled engine is different from a one off as many keep trying to portray the problem as.

            There are several points and times PW should have been grounded as well.

            The Qantas A380 RR failure is the way this should be handled. Inspect immediately. Consider a short term ground until you know WHAT happened.

          • Well, that settles it then and we can all go home now. The Philip has spoken and deigned to allow me my opinion.

          • @Mike Bohnet … I’m not talking about trashing the ODA system, but, the reporting lines of the FAA inspectors (Boeing payroll) reporting directly to the FAA personnel, rather that what they now propose of the FAA inspectors (Boeing payroll) reporting to Boeing management (in whatever capacity / unit / organization), and then to the FAA personnel. Boeing Management, however they label them, being inserted into the FAA-inspector to FAA-supervisory chain is what I object to.

          • Hi Richard,
            I get what you’re objecting to. However, the FAA director recently said reverting back to having the AR’s report directly to the FAA would require 10,000 additional FAA employees. This is not something that Boeing’s Aerospace Safety Committee can mandate. I suppose the committee could’ve made a statement recommending that the FAA go back in that direction, but it would’ve been just that, a statement.
            I believe the current ODA system at Boeing has AR’s reporting to their immediate engineering managers. The change that the committee recommends is removing the the AR’s from the normal engineering reporting chain and instead having them report up through the Product Services and Safety organization to the VP and the Aerospace Safety Committee. This is a sensible recommendation within the current ODA reality.

        • I think he means how to crawl out of a hole the company created by sloppy routines and execution, RR has been crawlinga bit longer on the T1000 than Boeing on the 737MAX. RR has done it a number of times before and Boeing after the MDC buy is quickly catching up.

          • Exactly why Rolls is not a great example for Boeing to follow.

  2. There was “nothing off the table” in the committee’s probe, Giambastiani said. “We were specifically not assigned the task of investigating the Lion Air and Ethiopian 737 MAX accidents…due to all the ongoing formal investigations.”

    This pretty much sum-up the value of the board’s work and Boeing’s commitment to safety…

    • “Giambastiani said BCA engineering reviews included airplane certification foundation; FAA organization; Boeing certification and Organization Delegation Authorization (ODA); jet airplane accident annual report; certification of the 777X and certification of the 737 MAX to see what differences there were between the two programs; pilot qualification training by the FAA and international regulators; and all the gated engineering processes.”

      The head of the committee said they investigated the 737 MAX certification process as part of what they were doing. The intent was never to do additional accident investigation. There are other very qualified organizations for that. It’s way more important for Boeing to straighten out their own processes.

      • It would be very confusing if the committee and the NTSB investigation came to two independent conclusions.

        • Do you suppose it is a coincidence that the Boeing committee issued its report a day before NTSB? Do you think Boeing was aware of the timing of the NTSB release?

    • Rolls-Royce are taking a long time because they need to do it properly.

      The way Boeing are going it’s going to take twice as long. People don’t forget.

      What’s going to happen to Boeing hasn’t even started, never mind finished before the end of the year.

      But have it your way. You have a right to your opinion. I’ve a right to mine.

      According to you it’s all over by the end of the year. To me it starts at the end of the year.

      Let’s see who is right.

    • Interpretation confusion: I read that as simply that specific investigation of the two crashes was not in their mandate, that does not mean that looking at the flaws in the _process_ that led to the bad design and related omissions weren’t. The CEO seems to be claiming that Boeing knows what happened, that would be valuable information for the board committee.

      OTOH, an overall look without taint has merit, certainly the board committee will have already been aware of errors like not updating the safety analysis.

  3. So, the Designated FAA Representatives, instead of reporting to Boeing managers, will report to the new Product and Services Safety organization within Boeing, instead of reporting issues and concerns directly to the FAA as it was in the past. It appears like a difference without a distinction. Boeing management will still be buffering information flow from FAA Reps within Boeing, to the FAA. That’s a problem.

  4. Of these I think this is the most important is: “Re-examine flight deck design and operation”.

    It has been shown repeatedly that partially automated systems should not make the assumption that humans can assume command of a complex and stressful situation at short notice. AF447 shows just how much trouble humans have with this.

    An explicit design point must be to degrade slowly enough to allow human operators to become aware of the current context and successfully take control.

  5. “Giambastiani said BCA engineering reviews included airplane certification foundation; FAA organization; Boeing certification and Organization Delegation Authorization (ODA); jet airplane accident annual report; certification of the 777X and certification of the 737 MAX to see what differences there were between the two programs; ”

    What came out of the “certification foundation” and ODA review?

    Looking at previous FAA policy’s on certification base:
    https://www.flightglobal.com/news/articles/faa-rules-kill-39grandfather-rights39-in-usa-and-europe-67064/

    and then what happened on the 777X:
    https://airwaysmag.com/wp-content/uploads/2017/06/Screen-Shot-2017-06-07-at-3.04.42-AM-1024×768.png

    got me a bit cross eyed.

    Even more when FAA-Boeing close cooperation under competitive / congress pressure was exposed.

    Who is gonna put the spotlights on that? To hot to handle?
    https://www.wsj.com/articles/fast-tracked-aircraft-certification-pushed-by-boeing-comes-under-the-spotlight-11553428800

    • “Fast track” requires clear product and financial goals, great people, and organization of the work (coordination especially).

      Few organizations are up to the task.

      Boeing impressed me during 767 development, they were focused on getting a good design and producing it, so avoided additional work until the airplane was flying and in service.

      Easy to get distracted under pressure, PW convinced them to spend time looking into HUD (which didn’t get far because of the lack of a supplier that was committed to a product (Sundstrand wasn’t despite having one airline in service) and mature (Flight Dynamics was not far enough along with their promising product). And a maintenance data system, PW decided against being the lead on such a system. Both desired options were offered by Airbus for the A310.

  6. Sean O’Keefe, former NASA administration and head of the Columbia space shuttle accident investigation. O’Keefe was also CEO of EADS North America, at the time the parent of Airbus North America.

    This is not correct.

    Sean O’Keefe was the NASA administrator when the Space Shuttle Orbiter Columbia disintegrated (over Texas) during reentry on February 1, 2003.

    Retired U.S. Navy Admiral Harold W. Gehman Jr. was the chairman of the Columbia Accident Investigation Board (CAIB). In fact, it was Mr O’Keefe who asked “Hal” Gehman to chair the board.

    https://en.wikipedia.org/wiki/Columbia_Accident_Investigation_Board#Board_members

  7. The Last Two Sentences Under The Heading “FINDINGS”

    “Giambastiani said that the Board committee found “categorically” that all the FAA standards, protocols, policies, processes and engineering functions were followed.”
    “The committee found no competing interests that would have compromised the safety of the MAX, Giambastiani said.”

    And yet within a few months of operation the B737 MAX lost two planes, and 346 people perished. This begs the question: Did they have to pay these people?

    • It’s possible, assuming that FAA policies, etc, were inadequate. And I think it’s hard to argue that they were adequate.

      And as much as I think Boeing screwed the pooch, I find it hard to believe that if anyone in position of power at Boeing had understood how badly compromised was MCAS, that they would nevertheless would have wanted to be produced. Even the most rapacious executives at Boeing had no interest in the outcome that resulted. The problem is they had an organization that was no longer capable of communicating these issues to the top and/or had people at the top who no longer were capable of understanding such info even if it was communicated to them.

      Americans, institutionally, religiously follow the letter of the law, even when it ends up with a clear violation of the spirit. The UK is a bit better at this, tending to frame matters in terms of principles.

      The 737MAX is itself an exercise in following the letter of the law beyond all reason. They’re still doing things under the rubric of the original 1960s certification of the 737-100, which is insane.

      The point is that the statements like “all policies were followed” is actually kind of empty, because as a nation we’ve made a pasttime out of obeying the letter of the law while totally violating the spirit. We’ll “fix” this by putting in a new set of regulations, which high-paid functionaries will then spend a lot of time figuring out how to interpret in the most advantageous way, even when the results clearly violate any kind of common sense. Even when such exercises result in situations that kill people.

      • I think a new Federal Aviation Regulation (FAR) is needed in the Part 25 – AIRWORTHINESS STANDARDS: TRANSPORT CATEGORY AIRPLANES. Something along the lines of EVERY control system affecting the primary and secondary flight controls of an aircraft needs to be described fully in the Pilots Operating Handbook (or whatever appropriate flight manual the
        FAA decides makes sense). It’s input control systems, sensors, software values, programming logic, priorities of
        events of control, decision tree, fault logic, failure modes, failure importance, pilot inputs, ability to counter
        act or turn off the system, which flight controls are affected by the system, and to what extent etc. Obviously, I
        don’t write flight manuals for a living, but, Boeing, being able to leave out any information about the MCAS software
        and it’s effects on pilots trying to understand how their plane flies is downright criminal. One of the first things
        mentioned in a lot of the ‘cheatsheets’ for problems in aircraft is to cut off the auto-pilot, cut off the auto throttle, and then take manual control of the aircraft. This immediately narrows down things that can be going wrong.
        With MCAS, there was no way to ‘cut off’ MCAS, short of shutting down the entire electric stab trim system. You were then left with a difficult plane to fly. Had an “OFF” switch been available to the pilots for MCAS, and they were aware of MCAS, then they may have had a chance to disable MCAS after identifying it as the problem. Will Boeing include an “OFF” switch for MCAS in their proposed fix? Going forward, in the future, what is to stop some airplane
        maker from sneaking in some other control system, without informing the pilots? I”m amazed that a regulation like
        this even needs to be proposed, but, intentionally hiding systems from pilots is insane.

      • Specifically, from what I understand today’s FAA does not have people to monitor the computer systems that run today’s airplanes. So, when it comes to software, they defer to what the company says. In this case, Boeing said “Trust me, we know what we are doing,” as far as MCAS.

        In reference to the second statement where they said that “…they found no competing interests….” I presume this refers to within the Boeing Company. Boy, that goes against so much of what we now know of the MAX development. Some wanted an NSA, others swore “No new build! Just iterations!” These statements come out of the camp that was concerned about more profits. Their judgment was clouded by this.

        • Enplanned:

          I will disagree on the US, Having been in the guts of the operations on a technical level, you usually find at least one if not several technicians and or engineers that cry out that the patch is going to create train wreck.

          The management stifles that as inconvenience of political ends.

          • Any organization, and in particular product-providing organizations, that is actually going to do something has to ship a product at some reasonably certain point in time. And although capitalism is much to blame here this was true in the Soviet Union and the pre-1980 PRC as well. There are always some people in the organization who will say at any given point that not enough was done and the choices made and implemented will lead to disaster. If you stop the development process for every one of these predictions it will be 2320 before your product ships and it unlikely anyone will lend you money for 330 years without a return. So at some point there has to be a cutoff and a decision to continue forward. Did Boeing make a Type II error in the case of the 737MAX MCAS [1]? It appears so, modulo a ton of hindsight, and posters in these threads have advocated for all kinds of ways to prevent that. What I haven’t seen is any recommendations on how to prevent an organization from seizing up due to Type I errors in the regimes proposed.

            [1] I suggest that the not making the AOA measurement a 3-sensor system with the necessary cross-checking and redundancy is perhaps the fundamental flaw. I would be surprised if no one on the design team suggested it, and when it was suggested it was probably classified as too expensive. Which again in hindsight was a bad decision

          • I can ( vaguely) remember some time back one of the top engineering managers at Boeing was talking about his job. he said ( from what I remember) that even with his background he didnt have a deep understanding of the finer details of the work his subordinates did. His job was to manage the people who did know and importantly set the timelines and be responsible for those.

          • Did Boeing make a Type I/II error? Are corporations more often then ever before in history making terrible judgement errors because of the Mantra “The Stockholder comes first?” Wells Fargo, BP, The oxycontin fellas, Uber, VW, … etc.,. I read “Reporter” by the NYT’s Seymour Hersh. He said: “You can go after the Government; you can go after the Military; but if you go after a corporation (like at the time the corrupt Gulf Western) you’ll experience more blow back than you can ever imagine.

        • Organization Delegation Authorization (ODA) seems a sensible idea given the complicated advances being made in aviation. Consider the B787-10 active flutter control system. That really needs a very sophisticated understanding of control theory. That’s a real advance but giving powerful veto and limited capacity to asses the FAA may prevent such innovations from being implemented into the market place. Remember there has been a 10 fold increase in safety since the jets of the 1960s.

          The Committee has identified that Aircraft may be flown by relatively inexperienced crews. The performance of the Lion Air 610 pilot was appalling, as was ET 302 and AF447 but should boing be putting aircraft into the sky that need elite 1500 hour co-pilots and 3000 hour pilots many with US military credentials The only reason that was ‘demanded’ by the market place was because of the large numbers of experienced B737NG pilots with that level as a hang over.

  8. I think the following is pretty important news relative to Boeing, safety and the MAX:

    https://www.reuters.com/article/us-ethiopia-airplane-transportation/us-transport-chief-warns-against-mixed-messages-on-boeings-737-max-idUSKBN1WA1Y1

    DOT Secretary Chao says it would be a mistake if the world safety organizations did not speak as one on the MAX. She’s right.

    Which seems to imply that she does not want the FAA to get out in front of e.g. the Europeans or the Canadians or the Australians on whether the MAX is ready to go back in service.

    Which is the right call. The FAA’s credibility was badly damaged by this episode. Folks will feel a whole lot better if the FAA stands with at least one other major safety organization if/when it recertifies the MAX.

    • Agree, but India has already said it won’t even start looking at the MAX until after the FAA lifts the grounding. No idea why, maybe they just want to see 300-400 aicraft accumulate a few million hours first, to be sure.

      Anyway, it kills the ‘all togther now’ routine.

  9. My first reaction is: has Boeing gone backwards?

    Design requirements are standard practice not only in the industry but were for at least software on the 787. Perhaps there weren’t high level flight deck/operational requirements for the 737, earlier models like it depended on capable people like flight deck chief Harty Stoll.

    (He and Dick Peale were still active for the 767 program.)

    Boeing used to have a change control/approval process called PRR, it did depend on people checking the right boxes but I think that other people would have noticed.

    (The 737 did suffer from inadequate design understanding – it lost chunks of flaps early in testing, the 747 suffered from inadequate design understanding – the engine was not stiff enough to withstand loads so it was failing. (Interim fix was a steel tube yoke around it.)

    I fear more bureaucracy in lieu of more smarts.

  10. Of course if workers and managers sluff off to meet schedule push, as happened early in the 787 program, things will be missed. Boeing engineering was living in denial of problems, despite the military division trying to tell them of the risk of fooling oneself. (Learned the hard way on the Wedgetail program, in which its lead customer publicly criticized it in the home area of its largest customer.)

    Recall of course that the battery installation was not though through.

  11. Well, they knew AOA vanes go out, so by definition of having MCAS linked to one AOA vane, they(Boeing as an organization) should have seen that it would erroneously activate a certain number of times a year. So my question is how did that slip by them, or if they were aware, how did they convince themselves it was easy to recover from?
    Kind of like the gear will drop down in cruise a couple of times a year but the pilots will deal with it just fine every time. Or they don’t have enough people checking other people’s work and are spread too thin.

    • My understanding is it was too many people working in isolation, the software guys didn’t understand the hardware, most people involved had no idea of the MCAS’s added power, etc.

  12. Was there anything at all about manufacturing quality control, FOD, etc?

    Realigning the engineering reporting chain around the chief engineer is one thing, but it seems to me that that’s only half of the problem addressed. Whilst authority to develop new products is not in the gift of the chief engineer, one of the chief engineer’s hands is tied. Running an effective engineering organisation is very difficult if the engineering staff cannot predict what they’ll be developing and when they’ll be allowed to do it.

    So far as I can see the committee is in effect recommending that the chief engineer be tasked with creating a lean, mean, can-build-it-quickly-and-properly engineering organisation, which will cost a fortune to keep up to scratch if the board then isn’t willing to fund it because they’ve temporarily decided that there’s no new aircraft models required.

    And indeed there’s no new models on the horizon; NMA might happen, but the case is already really thin. If not, from where then is there going to be a program around which the chief engineer and this “realignment” can focus?

    It’ll be interesting to see if Boeing last long enough to see any of this through to a beneficial outcome.

        • Vane failures are what is known in the real working world as cherry picking.

          They made a very specific determination on failed units.

          They did not address all failures of all types in the field (ramp damage to bird strikes which appears what occur on Ethiopian from the readings)

          That is a deliberate decision and criminal in fact if not law.

          Cherry picking to allow your data to stand.

          Japan went through the same thing with Fukushima Nuclear disaster. . Japan has one of if not the most comprehensive continuous history of events of all civilizations going back thousands of years in detail.

          For Scott and the Pacifi N.W. they logged the last huge Tsunami that hit the Pacific N.W. lo many years ago.

          Within that data set was the same class Tsunami that wiped out the Fukushima power plant and impacted a huge chunk of Japan (including endangered other nuclear wooer plants and a second near meltdown due to backup generator issues)

          Arbitrarily (read that as deliberately ) the design group for Fukushima Plant at Sea Level was allowed to cut off the data set such that the known Fukushima class quake was eliminated from it.

          That is the true art of Cherry picking and is exactly what Boeing did.

          While the top did not know about MCAS, the top set the culture and pruned the system so that it could occur.

          That clearly is not addressed.

  13. The problem of having “flexible rules” not following procedures since the 1950’s like reporting full test findings with documentation up the engineering chain and having engineering managers tick the check boxes sharing the test result and procedures with the FAA besides Boeing project managers and Boeing Chicago specifying and explain the extra work, instrumentation, software, testing with additional time and money required this time around.

  14. Many Max planes flew in the US and Europe and I never heard of any similar situation as the other 2. Some of this must deal with the pilots and training along with maintenance. I read where a pilot flying the jump seat of one of the affected airlines had to instruct the pilot when the MAX deviated from it flight course.
    Can the MAX be improved, of course and Boeing will see to it that it will be a very safe plane to fly in and I would have no trepidation in flying on the MAX.
    Too many are ready to kill the MAX as an unsafe plane whereas many have flown with no problem or at least the crew was able to make the necessary corrections.
    Lets all wait and see how Boeing deals with the finished product.

    • Steve: While there is some truth to what you say, MCAS was a goat rope from the git go that spiraled out of control and was not stopped.

      Pilots should not be put into a position where the automation is trying to crash the aircraft and in this case that is exactly what MCAS 1.0 did.

      That same culture that ensured that would occur is also working on new product as well as making cure3nt product decisions.

      When you have a safe practice and change it to save money then you have gone down the road to hell with the worst intentions. You hope you don’t get caught its the next CEO and you get away with your money.

      If I saw a report that was of the Columbia Shuttle class or the Maconda Oil rig ruling I would have hope

      As it stands its nothing more than eyewash.

      I will fly a MAX, but I will be happy not to fly a future new or upgraded aircraft as a guinea pig.

    • The original MAX design is now, officially, unsafe; it’s grounded.

      Yes, the MAX can indeed be improved. The question is, how much improvement is required before the regulatory authorities consider it “safe”.

      The next time a MAX flies it will be “safe”, or a least a whole lot safer. The tricky bit is that Boeing and various regulators are disagreeing about what it will take to make it “safe”. Boeing seem settled on software fixes. The EASA (and I suspect most of the other regulators) are not accepting this.

      The changes needed to satisfy the EASA might be uneconomic, and a new aircraft could be quicker and cheaper to develop. Furthermore, convincing the EASA and others that a software-only fix is acceptable is getting harder. Apparently Boeing have been refusing to answer regulators’ questions about AoA integrity, leading to a walk-out by regulators at some recent meeting. Annoying the very people whose permission is being sought to fly doesn’t sound like a good idea.

      Given the circumstances of the crashes and the aftermath, it’s not surprising that there’s a lot of people ready to kill the MAX as an unsafe aircraft. Even Leeham News have used the word “unprecendented”.

      • Put a number on how much it would cost to end the MAX program and dispose of all those frames, and pay penalties for not delivering the contracted frames? That is a huge number, so I think it is still cost effective to fix it as long as those fixes are less than 40B or whatever insanely huge number is at stake here

        • I suspect 40Billion would be over the top! Leeham News did a financial analysis some weeks ago suggesting I think that Boeing has already spent more money handling the MAX problems than it’d have cost to build a new aircraft. If the ultimate fate of the MAX is going to be scrappage, the sooner it’s done the sooner and more cheaply they’ll recover. Delay and they could fritter away a lot of resources

      • Mathew: The 737 MCAS 1.0 was lethally flawed.

        The does not mean the whole design is flawed.

        -The Manual Trim is a legacy system that was flawed from the 737NG (now the dual motors weigh in in prior 737 I do not know)

  15. At the end of the day it is down to this. Every company needs it’s own certification authority that reports exclusively to the regulator. Exclusive means it must be independent of a company’s reporting structure.

    I didn’t read that. I read the Organisation Delegation Authority that represents the FAA reports to the Product and Services Safety Organisation. The Product and Services Safety Organisation reports to Boeing leadership, presumably the board of directors, and to an Aerospace Safety Committee.

    Why doesn’t the Organisation Delegation Authority that represents the FAA simply report to the FAA and exclusively to the FAA. It can then report problems at will to the FAA. But the FAA does have to act on them.

    The oversight structure, as set out, is over-cooked. But then the purpose is to appear to have purpose.

    It needs to be remembered that it wasn’t just oversight that failed with the 737 MAX. Engineers were told they couldn’t do this or that by managers. The three biggest examples were:

    1) Raising the airplane to allow proper fitting of the engines,

    2) Larger stabiliser and elevators, and

    3) A new duplex/triplex channel FCC, with powerful CPUs, coupled to duplex/triplex sensors with full error logic to isolate failures. Preferably triplex.

    All three were possible in the 5 1/2 years it took to develop the 737 MAX. So engineers designed the 737 MAX with both hands tied behind their backs.

    Surprise, surprise, it all went wrong.

    • The short answer is Boeing need a change of culture not a continuous of a culture. This article simply shows Boeing’s determination to continue the culture.

        • I am very concerned that you have now agreed with me twice. Are you in jail or something and don’t have the money to pay the fine?

          I’m right about Rolls-Royce. If your not dead in 5 years the proof will be there!

    • I find it fascinating the level of knowledge that posters here have about Boeing’s internal design analysis and design/cost/schedule tradeoff decisions. In my experience that level of knowledge generally comes with quite strong NDAs but perhaps not in this case.

      However multiple parties who do/did have detailed knowledge of such decisions on the 737, including Joe Sutter, have on multiple occasions over many years publicly stated that increasing the 737’s height above ground any significant amount was the same amount of work as designing a New Small Aircraft, and would also remove the sales advantage of the low-to-the-ground design for ground handling and maintenance, so it would never be done until such time as a full NSA redesign was taken on. Apparently some here have more information than these public statements by key design authorities?

      • You are defending what cannot be defended. Hence the grounding. It needs to continue until Boeing face reality. Whether you like it or not, Boeing must face the truth.

        But keep offering the gibberish.

        • Some History
          ‘In 2006, Boeing started considering the replacement of the 737 with a “clean-sheet” design that could follow the Boeing 787 Dreamliner. – Flightglobal
          2010-“737 replacement decision may slip” Scott Hamilton-Flightglobal
          Feb 2011 “Boeing’s CEO Jim McNerney maintained “We’re going to do a new airplane.”

          And of course came July 2011 and American Airlines was talking about an order for Airbus neo…..and everything in the 737 replacement ‘master plan’ changed
          Sources above from Wikipedia 737 Max entry

      • Mike Bohnet

        You need to understand this word deduction. I for one cannot sully the great engineering history of Boeing a history that perhaps has it’s equal but not it’s better.

        Of course engineers at Boeing would have raised the airplane to fit the engine properly, of course engineers at Boeing would have enlarged the stabiliser/elevators to fix pitch authority, of course Boeing engineers would have full duplex/triplex FCC and sensors for fail-safe redundancy.

        Anything else sullies the reputation of Boeing engineers. You can do it. I won’t.

        Holmes to Watson:

        “Mediocrity knows nothing but itself, but talent instantly recognises genius”

        My words:

        Boeing’s past speaks for itself, Boeing’s present also speaks for itself!

        • You give Boeing engineers too much credit: even among the smart ones, nobody cares. Don’t assume that because Boeing was once a great and competent engineering team, they still play in the same league. Gone are the days that being hired as a Boeing engineer required you graduating near the top of your class from an aerospace engineering program. Since early in the 787 program, the eligibility bar has been dropped so badly, half the flight sciences staff can’t tell you (correctly) how a wing generates lift. A huge percentage in flight engineering jobs aren’t even aerospace engineers; look at the current leadership.

          • I’m retired. But in my day, Boeing engineers stood tall. A great second half of the 20th century. A rubbish start to the 21st century.

            Perhaps I should remember that we are already 19 years into the 21st century.

            So perhaps you are right.

    • Engineers were told they couldn’t do this or that by managers. The three biggest examples were:

      1) Raising the airplane to allow proper fitting of the engines,

      2) Larger stabiliser and elevators, and

      3) A new duplex/triplex channel FCC, with powerful CPUs, coupled to duplex/triplex sensors with full error logic to isolate failures. Preferably triplex.

      Care to provide any evidence that that Boeing engineers were told that they couldn’t do any of these things by their managers? You won’t find any because what you’re claiming here is simply not true.

      As for your list:
      1) sPh did a good job of covering why this was not done
      2) is not needed based on the basic principals of aircraft stability and control
      3) triplex is not needed because computer augmented fly-by-steel-wire aircraft don’t require the same redundancy as computer controlled fly-by-wire aircraft for the same level of safety

      • @Mike Bohnet

        I will desagree with you – MCAS is a piece of fly-by-wire technology – by his authority, range and necessity – not an augmentation system, so it shall have implemented FBW redundancy and robustness.

        • Pablo,
          The original MCAS did NOT have total authority because the pilots were able to battle MCAS action. We all know that on two occasions the battle was lost, but the fact that there was a battle at all proves that the original MCAS did not have total authority. MCAS was even successfully battled on at least one Lion Air flight before the crash. It is a fact that FBW has full authority and cannot be battled by the pilots. If an FBW system fully fails than the pilots can do nothing. Thus, MCAS is NOT a piece of FBW technology.

          • the previous discussion brought up to my mind — what’s the official definition of “fly by wire”. I’m not sure if there really is one. I did come across a good 10 page write up of “fly by wire”
            =====
            https://www.icas.org/ICAS_ARCHIVE/ICAS2006/PAPERS/050.PDF
            ==========
            after reading this, MCAS sure isn’t a safe, redundant system as fly-by-wire is designed to be.
            If MCAS is considered “fly by wire”, then when it fails, the aircraft should revert to ‘direct law’ .. it doesn’t. If it’s an augmentation system, then it should have warning indications according to FAR
            ========
            https://www.law.cornell.edu/cfr/text/14/25.672
            =========
            it may have had some (the AOA disagree light), but, it wasn’t working. What is MCAS supposed to accomplish? Two functions appear.. feel-ability of the yoke force, and stall protection at high AOA. Putting in a second AOA sensor certainly is better, but, is it good enough to accomplish stall protection and not trigger accidentally and with overpowering force and with some indications to the pilot that it is triggering. We don’t have the data. Boeing does. Boeing says that a second AOA is good enough. But, isn’t showing us the proof.

    • Mike Bohnet, I don’t think there is any secret that Boeing told engineers that anything requiring simulator training was dead on arrival. There are reports that SWA was told they they would get large rebates if new sim training was required on the 737-MAX. Some engineers have even spoken out in public.
      https://www.bloomberg.com/news/features/2019-05-09/former-boeing-engineers-say-relentless-cost-cutting-sacrificed-safety
      ======
      The 737 elevator, at times, is lacking in power to control the plane
      Two near 737 catastrophes because of no elevator authority … 737’s on approach and then close to stall and crash
      http://aerossurance.com/safety-management/de-iced-drama/
      =================
      https://www.gov.uk/aaib-reports/aar-3-2009-boeing-737-3q8-g-thof-23-september-2007
      ==
      as for the triplex AOA etc .. Boeing initially described MCAS failure as ‘major’, so they didn’t need as much testing and redundancy. I think now, (after two crashes and the planes being grounded) that is obviously not the case, and the FAA and EASA won’t buy off on MCAS failure being just ‘major’.
      They will require dual AOA at a minimum.

      • Richard,
        Yes, I know about the no simulator training “mandate”. That is not nearly the same as overall configuration and systems trade offs like raising the ground height or introducing a completely new FCC. Philip is projecting his own ideas of changes that the MAX needs onto the reports that engineers were limited or pressured to not make changes requiring significant retraining.

        The link you posted on the 737 elevator is about an incident where icing interfered with elevator motion. There is no indication that the 737 elevator has too little inherent authority.

        The MCAS that caused the crashes no longer exists. Who can say how failure of the new MCAS will be classified since no one here knows how the new MCAS behaves? Claiming that the 737 needs triplex redundancy because that’s what FBW systems have doesn’t make any sense.

        • Mike, Boeing takes MCAS seriously. They at the last moment upped the power of it from the .6 to the 2.5 .. without informing the FAA. They made it so it couldn’t be turned off. They tied it into the speed trim system, but, didn’t lower the power at high speeds. They made it activate every few seconds, with no limits. That doesn’t sound like a system that should depend on only one AOA sensor. It seems important enough a system that they aren’t ripping it out of the MAX, but, lowering the power of it back to the original .6 value, and having it activate only one time (I’m not sure when it resets), and maybe having an OFF switch. Previously, if the one AOA vane becomes invalid, the only option was to turn off the stab trim motor. You couldn’t turn if off. It would activate every few seconds. You were battling for the rest of the flight with it, unless you turned off the stab trim motor. When you did this, and the plane wasn’t in a good trim, you were then fling a badly out of trim aircraft ,with just the elevator, flaps and maybe the spoilers for pitch. Obviously, the pitch up issue near stall is serious enough for them to keep MCAS in the max. And they’ve known this since the wind tunnel testing. But, for some reason from test pilot reports upped the power to 2.5. Boeing hasn’t shown the world what the numbers are on the pitch up problem. They are saying we need MCAS, and hopefully a .6 degree and only one firing of MCAS is good enough to pass inspection. And if the AOAs disagree by more than 5 or 5.5 degrees we’ll turn MCAS off. But, how many times a day MCAS activates hasn’t been published, if known. I doubt it’s very often, but, we don’t know. And the full description of the pitch up problem, Boeing seems to be saying “trust us” . EASA seems to be asking for a fuller explanation. The FAA isn’t.
          I don’t trust Boeing. They hid MCAS originally, and now won’t come forward with the data. A tweak in the software values and only activating once, and every thing is good. Trust us. I want to see the data.

          • Richard,
            Of course Boeing takes MCAS seriously. I firmly believe that MCAS was a “need to have”, and not a “nice to have”, otherwise they wouldn’t have put it on the airplane. If the revised MCAS is classified as “hazardous” as opposed to “major” then fine, the revised MCAS will use two AoA vanes instead of one. I do not agree, however, that revised MCAS will require a triplex FCC as some here insist. It will not be powerful enough to require it. Note that I’m basing this on my assessment (opinion) of what I think MCAS needs to do, not what the hosed-up original MCAS did.

      • Of course MCAS failure was not the issue. (Needing MCAS and having it fail to function) The issue was MCAS deploying when it was not supposed to. What was this classified as? Similar to if the speed brakes, flaps, or rudder goes full over when it is not designed to.

        • And who had ultimate control of MCAS? The Left AOA sensor and the Flight Control Computer. Not the pilots. I hope in MCAS ver 2, the pilots have control of MCAS, as in an OFF switch. Of course, they then have to be wary about the pitch up tendency at high AOA. So, that may necessitate sim training. (and lots of money to SWA etc)

    • Further, Mike Bohnet

      @sPh justification for not raising the airplane was money not engineering. But we all know safety has a price on it’s head at Boeing.

      But your explanation as to why there isn’t a 2/3 channel FCC with 2/3 sensors is to say the least imaginative. What’s steel cables got to do with connecting CPUs in a multi-channel configuration. NOTHING. And what’s steel cables got to do with connecting the FCC to muliple sensors. NOTHING.

      With regard to stability. There is clearly a pitch authority issue, otherwise MCAS wouldn’t exist. The use of the trim stabiliser by MCAS to manuever the airplane can only have one explanation. The elevators don’t have the authority.

      But I do think your imagination got the better of you with your explanation for not having a multi-channel FCC using a multi-sensor configuration. Steel cables. I need to remember that one.

      So to sum up. Money is the response to my first point. MCAS exists for no reason at all is the response to my second point. And steel cables are the response to my third point.

      I thunk you are proving my points have merit.

      • = = = @sPh justification for not raising the airplane was money not engineering. But we all know safety has a price on it’s head at Boeing. = = =

        I did not say that, and I’ll thank you not to attribute to me statements and arguments that I did not make.

        What I said, in response to your statement that the 737 landing gear/height above ground could have been increased during the MAX design process, was that knowledgeable experts with design authority over the 737 have stated over the a number of years that increasing the landing gear height is an undertaking that would be equivalent to designing an entire New Small Aircraft (NSA).

        You then combined that with your deep knowledge of confidential business discussions inside Boeing to infer that the reason was “money”. Had you stated that it was your opinion that a major contributing factor to the decision not to initiate an NSA project was an attempt to capture more profit by the Boeing board I would not have disagreed with you that that was one factor. [1]

        However what those who criticize Boeing for continuing with the 737 upgrades continually ignore is that Boeing’s customers were, as far as we can tell from the outside, not interested in an NSA at anything except a much lower cost than the 737, which is highly unlikely to be the case. The A320 has been on offer for 30 years and now the NEO for 7 years and yet airlines continue to buy the 737. There are operational and cost advantages to some airlines in continuing to operate the 737, there are airlines and pilots that have expressed a preference for the 737’s handling characteristics for their route profiles, and I infer that a significant number of customers (including I would hazard two very large ones) told Boeing they did not want the NSA but did want an updated 737.

        It is quite easy for armchair industry analysts to spend Boeing’s money and customer relationships in pursuit of a shiny new design that they think would be “better” or “less archaic”. Ignored in that is not only the difficulties of making choices and tradeoffs with real money but the historical fact that new designs with new technology bring with them new problems, new failure modes, and new marketing gaps. Digital technology is not a magic wand that makes everything everywhere better with no cost.

        [1] I would also argue that the Boeing BOD’s bad decisions and hidden goals with the 787 program, resulting in the well-known failures thereof, continues to affect and constrain decisions being made about new programs down to this day.

        • In short, if it’s not safe don’t build it. But thank you for explaining it to me.

          It’s part of the problem. But, the failure to raise the airplane resulted in engineering decisions that were not safe.

          Live with it. But then live with everything else.

        • By the way, I will add.

          I once said on this web-site, for the want of a nail the shoe was lost, for the want of a shoe the horse was lost. A very old proverb. It dates back to the 13th century.

          The left alpha vane is the nail. It failed, the airplane was lost. Not lost once but twice.

          Why did Boeing engineers end up having to rely on a single nail. Don’t you think humanity can do better than that?

          Humanity does deserve an answer.

          You are defending what cannot be defended.

          • I’m not defending anything. While I enjoy reading aerospace sites as part of my interest in all things at the interface of technology, complexity, and human capability/nature I do not work directly or indirectly for any aerospace entity [1]. When I see long-running threads across multiple OPs that defy the basic principles of engineering, business, and reality, and which reduce every explanation to a conspiracy of the incompetent evil (or the evil incompetent depending on whether it is an even or odd day of the month) I do take a few minutes to point that out.

            [1] I have worked at process plants and with process controls systems that included gas turbine power units, and I have some thought on the generally bad state of man-machine interface that crosses industries as a result

          • @sPh

            Of course you understand engineering principles and of course you know about conspiracy theories… and so on.

            Words that appoint you the judge, the better of others. Many on this site are far too enducated to be taken in by it.

            How about explaining the engineering principles that say my points are wrong? Mike Bohnet at least had a go but unfortunately showed he doesn’t understand engineering principles. But he is to be respected for trying.

            So for example, why does it cost the money equivalent of a NSA to raise the airplane? In other words, $10-15billion. Seems somewhat high. Not cost Boeing that for the 777X, remembering is has a spanking new undercarriage.

            Indeed with the 777X, Boeing are doing everthing right. All the bits that need changing have been changed. So it’s about execution. If the execution is wrong, it will go wrong. But at least there isn’t anything wrong with the overall design.

            Anyway you were addressing money. Your last post addresses nothing else.

            So remember – as you indicated yourself – Boeing told airlines that the 737 MAX would be at least on a par with the A320NEO and have no increases in operating costs. A case of swap a NG for a MAX with no change. Of course the likes of SouthWest jumped at it.

            In other words, Boeing’s managers tied engineers hands behind their backs from the beginning. The result an unsafe airplane. I bet Boeing didn’t say that to airlines

            It doesn’t cost $10-15billion to fit a spanking new undercarriage. Engineering principles say that’s total rubbish.

            Your argument with regard to the 787 will be the concern with regard to the 777X. Can Boeing execute? Even if they do, it won’t be good performance wise. The A350 is getting better by the day.

            People on this site are far, far, far more knowledgeable about engineering principles than yourself. That’s me judging you.

  16. “The board recommends that engineers throughout Boeing, including the new Product and Services Safety organization, report directly to the chief engineer, who in turn reports directly to the company’s chief executive officer.”

    That this recommendation has had to come out of a board of inquiry is funniest thing I’ve read about a supposed engineering company ever.

  17. They already have the chief technology officer( a new fangled term for chief engineer) reporting to the CEO

    • True, and one of the “outside experts to assist in [the Safety Committee’s] probe of BCA’s safety processes on the MAX” is none other than John Tracey, Boeing’s CTO during MAX development. So much for “outside” and “expert”, apparently. This appointment alone gives little credence to any substantive change being forthcoming.

        • Disregarding the spelling variation of the name, the MAX program started in 2011 during Trac(e)y’s watch. And this from AvWeek (9/25/19):

          “Boeing’s chief engineer had all these engineers reporting to him or her at one time,” Giambastiani said, adding that former Boeing chief technology officer and SVP engineering John Tracy provided the committee key historical perspective. “We have modified that somewhat over the years. It’s almost back to the future here … having engineers report up the engineering chain.”

          So did engineers begin reporting to bean counters and salesmen before or during his reign? Why didn’t he change or oppose this tendency? Like, perhaps, resigning in protest. Kind of makes one think that Boeing’s CTO was a mostly ceremonial position. Will the new, improved CTO have any real power?

          The problem was/is poor systems engineering practice, which allowed the MAX to exceed its design constraints after “bending metal”, thus not only necessitating MCAS, but then also not analyzing emergent system behavior (human-mechanical).

          • Dean, A Jones, Boeing was bought out by McDonnell Douglas back in 1997. I know others may say the opposite, but, in actual management, they did, with Boeing’s money. The 737-MAX should be renamed the MD-13. That’s it’s historical legacy. The DC-10, the 787 etc. All grounded planes at one time. Engineering took 2nd place to the bean counters in Finance. The score keepers were now coaching the team. With the obvious results.
            This article from 2013 .. just replace the names and the planes and you have the current situation. McDonnel-Douglas management (now called Boeing) hasn’t learned it’s lesson.
            ====================
            https://www.newyorker.com/magazine/2013/02/04/requiem-for-a-dreamliner

  18. When I read these “findings” once and again what strucks me is there are lots of very smooth-gummy-bear words and not much quality in them, nothing substantial. Anybody in practice can interpret those findings as wish and always claim that fully followed them, it is a good example how to change a flawed FAA’s new ODA system without changing it almost at all.

    I have to incline to @Philip view that this Boeing’s inside commission has simply failed – they could have achieve 8 or 9/10 but they reached only 1 or 2/10. Maybe because they were paid by Boeing to find nothing, at least indirectly because they felt they couldn’t do otherwise in this business if they want stay in it, or just were unable to make a difference for other reasons. It ended up that the commission appointed by Boeing’s board made some indistinctive critic that in fact supports Boeing’s board.

  19. @Matthew: “The question is, how much improvement is required before the regulatory authorities consider it “safe”.”

    The required technical solutions would be financially unacceptable for Boeing. Therefore this issue can only be resolved at the political level. The United States of America is still the most powerful country on earth and I can only imagine what’s going on behind the scenes right now.

    • @Normand Hamel

      Unfortunately you could be right, and we will have a new safety category “politically safe aircraft” or “US only safe aircraft”. And I opt for the latter.

      • Without international sales the 737Max is unsustainable. Forget the idea of US only aircraft.
        Residuals would be destroyed and the whole financial side which supports buying new planes and leasing dives faster than a 737 under MCAS

  20. While the plan seems good, I’m still curious as to exactly what happened. Did one person expand MCAS and link it to one AOA? Did four or five people collectively agree that an expanded MCAS linked to one AOA was fine? Or did four people say that it was not a good idea, and managers overruled them and said that is the way it should be done?

    Specifically knowing exactly what happened seems the most important thing to knowing how to fix it.

    • That is what is being investigated now. With Boeing trying to focus on the isolated problem and it’s solution & the ROW on how this blatant design error got certified and if other certification followed the same route.

      The risk of grandfathering certification & requirements on as many subsystems as possible and being “conservative” on identifying issues on (human) interfaces.

  21. @sPh: “There are operational and cost advantages to some airlines in continuing to operate the 737, there are airlines and pilots that have expressed a preference for the 737’s handling characteristics for their route profiles, and I infer that a significant number of customers (including I would hazard two very large ones) told Boeing they did not want the NSA but did want an updated 737.”

    Yes, and the whole Max’s business case was built around the requirements of these two US based customers.

    This might have been judged to be absolutely necessary to do at the time but it was also a very dangerous thing to do. For Boeing has put all its eggs in one basket that has since fallen out of the sky.

    But there was a third customer, and a much more important one in the eyes of the Boeing Board of Directors than these two, that they were trying to please at the time: the shareholders.

    Had Boeing pursued the NSA instead of the Max the shares would certainly not be at the level they are right now. But on the other hand the future would arguably be much brighter though.

    • In the realm of pure speculation, other continents and areas under the auspices of aerospace regulatory agencies other than the FAA, but would follow the United States’ lead – there could be South America, and Asia and Africa even though that’s were the MAX casualties took place. The banning of the MAX could be on some level a European issue.

      • Hello …Lion Air ( Asia) . Ethiopian ( Africa).
        The idea that its a european thing is bizarre, I understand the agencies outside US ( and are fully involved in certification not just rubber stampers like my country is) are agreed on their approach. They are technical people and understand fully the implications.

        Thats why the NTSB got in first and fired a shot across the bow of the FAA who could have commercial and political considerations dominate their decisions.

        • Could be a moot point. Just speculation. But in reality, the MAX from what we’re being led to believe will mostlikely be flying world wide the first of the year give or take a month.

          • Thats true. Boeing may be just showing its bargaining hand and may have backup approaches just as ready to go.
            After all a $100k fix per plane is desirable the $1.0 mill fix still works if it can start delivering planes with that

    • – – – – – Yes, and the whole Max’s business case was built around the requirements of these two US based customers. – – – – –

      I can only go by what I read in the general business press, however based on that IMHO only one of the two largest customers was US-based. And there were others besides the largest ones that told Boeing the same thing.

  22. @sam walker: “Other continents and areas under the auspices of aerospace regulatory agencies other than the FAA would follow the United States’ lead.”

    Please let me rephrase this:

    Other continents and areas under the auspices of aerospace regulatory agencies other than the FAA would follow the United States’ command.

    As for EASA they have already made a complete reversal this week and apparently went into submission. Here are two excerpts from the Associated Press:

    AP1: “Patrick Ky, head of the European Union Aviation Safety Agency, told a French aviation publication that a European decision could follow within a few days of an FAA approval and under the same conditions.”

    AP2: “Just a few weeks ago, the European agency was suggesting that it might make demands on Boeing beyond what the company is planning, including requiring additional sensors, which could delay the plane’s return in Europe.”

    https://apnews.com/202c473b7a3344f1a91d26fe3f384ee2

    • That AP-News would be straightest and latest from the source. Only statement that would indicate delays of any magnitude would be adding sensors. But early on in this event, Boeing had certain sensors as options, so the hardware and software might just be plug and play.

  23. “significant number of customers (including I would hazard two very large ones) told Boeing they did not want the NSA but did want an updated 737.”
    Look back at my earlier comment about the NSA and 737 Max ‘mini history’ ( taken from sourced Wikipedia details)
    Boeing wanted a new NSA which as a Scott Hamilton said a decade ago ‘would be in service around 2020’

    • If it rains it pours.

      Thankfully the structure will have been designed with fail-safe redundancy. Specifically independent load paths that will take the load in the event of a load path failing.

      It been caught. That’s the good thing..

      To @sPh and @Mike Bohnet. I don’t have the evidence that Boeing have designed the structure with fail-safe redundancy. It’s deduction. I don’t think Boeing engineers are that stupid. But then one poster did say that I do give Boeing engineers too much credit.

      If what I’ve said is wrong, the 737 NG must be grounded, otherwise wings are going to fall off.

      • @Philip: “If what I’ve said is wrong, the 737 NG must be grounded, otherwise wings are going to fall off.”

        Only those where some cracks of a certain length will have been found during inspection will likely be grounded while the others will be monitored closely but allowed to continue flying nevertheless.

        Anyway, I don’t think this is a design issue but rather a manufacturing issue. Possibly some metal defect in a certain batch. This sort of thing could have happened if for instance they changed the supplier for that specific part.

        It is still a serious issue but nothing out of Boeing’s control. It looks worse than it actually is only because it is happening in the context of the Max grounding.

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