Breaking News: Congressionally-mandate safety study finds flaws at Boeing (Updated with Boeing comment)

Feb. 26, 2024, © Leeham News: A Congressionally-mandated safety review study of Boeing Commercial Airplanes (BCA) dropped this morning. The 50-page report of a committee appointed by the Federal Aviation Administration found serious flaws in Boeing’s safety culture despite years of attempts to improve.

LNA is still absorbing the study, which may be downloaded here: Boeing Safety Study by FAA Panel 2-26-24

The Executive Summary is synopsized below.

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Executive Summary
  • The Expert Panel observed a disconnect between Boeing’s senior management and other members of the organization on safety culture. Interviewees, including ODA Unit Members (UM), also questioned whether Boeing’s safety reporting systems would function in a way that ensures open communication and non-retaliation. The Expert Panel also observed inadequate and confusing implementation of the five components of a positive safety culture (Reporting Culture, Just Culture, Flexible Culture, Learning Culture, and Informed Culture).
  • The Expert Panel found Boeing’s SMS procedures reflect the International Civil Aviation Organization (ICAO) and the FAA SMS frameworks. However, the Boeing SMS procedures are not structured in a way that ensures all employees understand their role in the company’s SMS. The procedures and training are complex and in a constant state of change, creating employee confusion especially among different work sites and employee groups. The Expert Panel also found a lack of awareness of safety-related metrics at all levels of the organization; employees had difficulty distinguishing the differences among various measuring methods, their purpose, and outcomes.
  • Boeing’s restructuring of the management of the ODA unit decreased opportunities for interference and retaliation against UMs, and provides effective organizational messaging regarding independence of UMs. However, the restructuring, while better, still allows opportunities for retaliation to occur, particularly with regards to salary and furlough ranking. This influences the ability of UMs to execute their delegated functions effectively.
  • The Expert Panel also found additional issues at Boeing that affect aviation safety, which include inadequate human factors consideration commensurate to its importance to aviation safety and lack of pilot input in aircraft design and
Failure to implement safety procedures

The panel was not directed “to investigate specific airplane incidents or accidents, or to make recommendations toward a specific airplane incident or accident, which either occurred prior to or during the Expert Panel’s work,” the Executive Summary continued. “However, on several occasions during the Expert Panel’s activities, serious quality issues with Boeing products became public. These quality issues amplified the Expert Panel’s concerns that the safety-related messages or behaviors are not being implemented across the entire Boeing population.”

More reporting will be forthcoming.


A Boeing official responded, “We transparently supported the panel’s review and appreciate their work. We’ve taken important steps to foster a safety culture that empowers and encourages all employees to share their voice. But there is more work to do. We will carefully review the panel’s assessment and learn from their findings, as we continue our comprehensive efforts to improve our safety and quality programs.”

Additional Boeing comments will appear in tomorrow’s LNA post.

SPEEA, the engineers and technicians union and a member of the Expert Panel, issued its own statement:

“SPEEA welcomes the report and believes it can be a catalyst for positive change at Boeing.

“Our members have long reported a disconnect between the messaging they get from Boeing headquarters in Chicago or Virginia, and the messages they get from their direct supervisors here,” said SPEEA Director of Strategic Development Rich Plunkett. “Quality and safety must be The Boeing Co.’s core values, embraced by everyone, but the report reflects the reality that people who see something are afraid of saying anything for fear of jeopardizing their careers.

“Our union has proposed an Aviation Safety Action Program, in partnership with Boeing and the FAA, that would allow our members to come forward without fear of retaliation whenever they spot a production or design error – or make one themselves,” Plunkett said.

“We hope that Boeing will accept our proposed program so that together we can work to restore Boeing’s reputation for quality, that generations of SPEEA members worked so hard to achieve.”


39 Comments on “Breaking News: Congressionally-mandate safety study finds flaws at Boeing (Updated with Boeing comment)

  1. It seems all we need to know about Boeing’s safety culture can be encapsulated in them making “safety” only 4% of total executive bonus compensation and scoring themselves 20/20 (perfect score) on the safety metric for 2022.

      • dream on and on and on.
        Clawbacks scheduled to happen when hinges of hell are frozen plus a milleneia

        • +1

          Clawbacks on exec compensation? Ha ha ha.
          That’s thrown out there as bait for the Rubes, and will never, ever be implemented [“it’s unworkable”].

  2. Simpler summary – Boeing version re safety and quality
    ” Joe/Josephine/Them – When/ IF we want your input/opinion we will tell you what it is. We have an open door policy- remember it swings both ways. “

    • Yes, of course: more Theatre forthcoming.

      “we’ll get to the bottom of this!” heh, sure

      • Boeing said “737 safest plane ever”

        I wrote else where on site that a grounded plane is super safe.

        if a grounding is fallout from this examination
        the Boeing spokesperson would not have directly lied 🙂

  3. It’s often said that there is a correlation between workplace accidents and lack of investment and huge company disasters like Boeing is experiencing.It was certainly the case with BP.
    Anyone seen the workplace accident numbers for Boeing?

    • Actually I may have got that the wrong way around,my memory fails me.Maybe BP was complacent because the numbers of minor accidents was falling(which tend to get noticed by the accountants) and not focused on the big accidents

  4. Thanks for this important post. I wonder what of significance
    will happen at Boeing in direct response to said report.

  5. We all know Boeing has it’s share of issues. What would be even more interesting is an independent study on Congressional performance !!

  6. The Post is valuable and I will be reading the details.

    Its not simple though that its just Boeing. Unfortunately its political and that is a reality.

    Just because you can commit a crime does not begin to mean you should. Boeing Management is a perpetrator in this as they elected to commit the crimes. Most of us just try to live decent lives with as much integrity as the system allows.

    As citizens we are complicit as a body even though some of us try to change what is. Its a twist of the world, politics and its extremes push things. One person or even a group of people cannot change what lean or outright not even close as to what party gets elected.

    Congress is complicit but it needs to be recognized what makes congress complicit. A huge part is money to get elected again.

    A sub set of the House of Representatives (US system is not like a Parliamentary system) and their 2 Year Term. As soon as they get elected they have to start collection money for the next election (they had to want to be there in the first places so staying there is important, even if its in their own mind important)

    Campaigns have gotten hugely costly, the Senate is part of it as well, those positions are worth even more as there are only 100 of them.

    And then we get into a combined problem. Boeing and Corporations have money to corrupt the process and they do and its allowed.

    Congress when they take action is undermined by the Supreme Court when it revokes those actions on campaign funds and declares a Corporation having the same rights as citizens do.

    The only time that corrections take place is during crisis (2008) and then congress and the Supreme court begin to undermine what was done (small banks being declared small when they have hundreds of billions in assets) – specific language of who can appoint a position changed.

  7. From the report: ” Some interviewees mentioned a briefing was provided by Boeing legal prior to the interviews”. Legal safety above all?

    • ..and the “chilling effect” of same.

      “Careful what you say, boys and girls..”

  8. I think the report, while thorough on the surface, misses the elephant in the room, which is the overall system of values. They talk about five elements of culture, or separate cultures as they describe them (reporting, just, flexible, learning, and informed ), which could have provided a way of digging into the bigger issues, but they chose to not go there, and instead focused on what they called the “safety culture.” That is not one of their big five, but rather a symptom of the others, and they turn that upside down.

    Even then, that doesn’t quite get at the values issue. This stuff isn’t new. It’s ancient. Perhaps one of the most impactful writings on the topic was in the fourth century by a Greek named Evagrius Ponticus. He wrote a lot of essays, which were later translated into Latin, and one of them caught the attention of Pope Gregory I, who dealt with a translation issue by changing the list to seven items. Shortly after Ponticus’s essay was written, a poet named Aurelius Prudentius Clemens wrote a poem (Psychomachia) describing the inner struggle we all face in the tension between virtues and vices, which appears to use the essay of Ponticus as a starting point. From Pope Gregory’s essay on these concepts, the two lists (vices and virtues in seven pairs) have been part of the vernacular of every language touched by western philosophy.

    The problems at Boeing are really quite simple. Starting with Harry Stonecipher, the vices were adopted as the virtues and modeled as such my him, Phil, and every leader and board member who followed in their footsteps, the big exception being the silent board members who are ex-military and who have the role of overseeing the classified programs. If you want to get promoted through the leadership ranks in Boeing, you measure what the boss wants to hear about and you make sure you meet your numbers. And the perfectly incestuous compensation committee stacks the reward system to reinforce that, amplified by the now standard American corporate greed factor, which is running about 10x (i.e. a reasonable compensation package for the work performed times ten, which is how they perverted the whole 10x quality thing).

    Wanna fix Boeing? Slash the executive salaries by 90%, make them go to work every day, and require every exec to show up on a factory or engineering floor for a full shift at least once per month, and actually perform one of the daily productivity tasks much the way Bill Ford did when he started working in his great grandfather’s company – No photo ops or reporters around – just the person modeling behavior that shows they have a sense of humility and that they actually care.

    I learned on my second day of work at Boeing back in 1983 that one should expect to look up occasionally and see T Wilson in the room chatting with the squirrels as he called us. It was no big deal, and yet it was a very big deal.

    Wanna fix Boeing? Hire some leaders with a clue about basic ethics as Prudentius described them over 1700 years ago. That might also be prudent.

    • RTF:

      Thank you for the history lesson, its good to be reminded that the same struggle has been going on forever. As one person noted, I don’t expect a big win, its a chip here and a chip there and I hope one day the chips add up.

      I forget how many different stupid processes I was exposed to (my company did not of course but FedEx did). As I recall it was 7 Pillors of Wisdom, the 5 Something, 6 Sigma, Black Bets something etc.

      The real bottom line is as you noted , its got to mean something and people have to be engaged and believe it.

      The funniest one came due to us being on an executive memo list (huge mistake). The one where the head guy in exasperation put out, this is not just lip service, this is how we are supposed to be operating. What a hoot. Honeywell by the way. Someone finally twigged to the fact that the riff raff were not supposed to be getting those memo;s. Sad day, our entertainment went away as well as stuff we used to beat our management over the head with.

      By a twist of whatever, we wound up under one of the company operatives, whose job was to slip knives into backs. I had a series of issues that were dismissed and the one I had them nailed on because it was in print, oh, you are right, but that is policy and the policy has been changed.

      Never ever go up against 00X, they have a license to kill, even if its metaphoric.

      It does not matter what process you have or use, its if you actually believe in it and the true goal of doing it right.

      Reading the Art of Motorcycle Maintenance is worth it, until I did I had not seen how I worked articulated. Quality was a major aspect and that is what I tried to do in my work, quality. Success always? No. But at the end of the day I knew what I had done wrong and worked to correct it and not repeat it.

    • Great history lesson. I always enjoy your posts. Here’s one I’m going to re-post, echoing your sentiments:


      You cannot understand how absolutely simple it is, for Boeing to solve it’s production issues.

      If Calhoun was living near the Seattle area and actually worked in the same buildings, all he would have to do is:

      1) Take one hour, every day and visit the plant(s). Leave your phone in your office.
      2) Wear what the employees wear, safety shoes, goggles, whatever
      3) Don’t do it with an entourage. No press. No underlings.
      4) Stop 15 minutes at random places and engage with the workers;

      “Hi. I’m Dave. Pleased to meet you. Tell me, what are you working on here? Can you show me?”

      After a few minutes. “Can I try one? Yah – don’t worry, if the Union files a grievance, I’ll pay it, no questions asked. I want to know how this works. Money well spent.”

      A little while longer “Is there a better way to do this? Anything you missing here? What’s that? Tough to get enough ear plugs… (pull out a notebook). Ok Thanks”

      And you move on to the next station. The next day, you personally go down with boxes of ear plugs and fill up the station.

      Install some seats with the seat guys. Put in a few rivets. Help run some wiring. Watch them power up the plane for the first time. Ask if you can push the button. Call the people by their first name and ask them to do the same to you.

      When a problem arises, you ask; “What’s the right way to do it? Then let’s do it that way.”

      Every day. Visit different shifts. Get dirty. Encourage other C-suite people to do the same thing. Don’t make a big deal of it.

      When an aircraft rolls out of the factory, be there. Take a moment and look at it. Turn to some workers around you and say “Look at this beautiful thing you’ve created. Its a marvel and you’ve done great work”

      If you show them you care and are proud of the work done, they will follow you.

      • Right on- right on- a long ago now retired VP-Program Manager at Boeing used to have monthly ‘ breakfast’ meetings with a random selection of worker bees. Asked for input on what was right or wrong. Sometimes not much real response- but as he explained , his best results as to problems/gripes. etc was when some ‘ brave’ soul politely stood up and told him in no uncertain terms what “he” could do with the ‘ recent ‘ reporting or direction about xyz or similar which caused an unreasonable effort for a BS result or issue. When the rest of those observed that said person was not struck by lightning ors received a BS answer but requested a suggestion as to how to ‘ fix’ or change- the whole conversations became worthwhile – AND if at all possible- such suggestions were rapidly implemented or errant supervisors were ‘incentivised ‘ to go fix NOW.

        • “It’s the information age! I can do all my CAD drawings from home with no distractions,.It’s cruel to make me come in to work “
          If you are lucky,these drawings will be intercepted by people who live in the real world before too much damage is done.With engineering it seems to still be necessary to actually look at the physical parts and wave your hands around whilst communicating with less well educated individuals. I am sure that the great A380 wiring disaster would have been avoided by listening to the electricians

      • “If Calhoun was living near the Seattle area and actually worked in the same buildings…”

        I heard Calhoun isnt even coming into the Washington office much, working remotely from his home in Maine.
        The CFO does similar in Connecticut, but from a Boeing ‘pop up office’ near his semi rural home
        The actual in person meetings mean a corporate jet is used to get to the city

        • The most important products, the ones that generate the most revenues, are the commercial and military aircraft that BA delivers to it’s customers. In 2018:

          Sales of products $90,229
          Sales of services 10,898

          Total revenues 101,127

          Looks like some 90% to me.

          Why would you want to be so far away from the most important places? Shouldn’t you and top management be RIGHT THERE, making sure things are done right? (OK, there in SC and the other locations, which can be visited, but still…).

          If you care so little and prefer to stay at home, what example are you setting for those you are leading?

          “I’m the best paid guy here and I’m checking out. But you need to stay vigilant…”

      • With the added point that the employees being visited must also show they care. If you are senior visiting shop floors etc and it is clear any employee is not on board discuss to understand why but take them to task as necessary, and be seen to do it.

      • Fifteen years of my working career was working at Hewlett-Packard, while Bill Hewlett and Dave Packard were still at the helm. The H-P culture was back then known as ‘management by walking around’. Yes, time have changed, but I have fond memories of meeting both of these gentlemen who walked the walk…. sadly it’s long gone, as far as I know.

        • MBWA (Management By Wandering Around)is a key item of “in search of excellence” the still very valid classic best seller of Waterman and Peters.
          I have personnally practiced it daily during my full industrial career.
          In the same philosophy, IKEA practices “anti bureaucratic weeks” in which white collar people have to spend each year one full week on the shop floor along blue collar people, pushing pallets, or welcoming customers…

          • BA version sort of a throwback to old andy rooney movies ‘ lets put ona show ” – BA version = ‘ lets add another layer/committee as an safety check/insulator – for our posterior covers ‘

          • I heard of another version when shop went on strike and the company sent down the white collars to do the work, they soon found out lots of problems and ordered new equipment, the interesting thing was that blue collar workers had reported the same problems almost back to the pervious strike. So when the shop workers came back with new salaries they could just check off the old complaints that had been fixed/replaced and plan for the time of next strike when the shop needed a new uplifting.

    • Well said, with the added bonus of references to the classics.
      Of course, we all know that expecting this gang of Jack Welch clones to fix the problems here is a fools errand. How can Calhoun be expected to fix Boeing when he and his business philosophy are what broke it? For this to happen Calhoun would need to have a “road to Damascus ” moment. He would need to accept that, essentially every big decision that his group made involving $$$, was wrong! The whole regime of relentless cost cutting and squeezing labor and suppliers till they bleed is just plain wrong for this industry. To fix Boeing Calhoun would have to have his own George Costanza moment, where he realizes that every instinct he has and every decision he has made were all wrong, and vow from here on to do the opposite of what his judgement tells him.
      I laugh when I hear Calhoun say he has confidence in the quality of Boeing planes. Afterall, how would he know?

    • It is one thing to define a quality system, another is teaching and check that it works as intended. Each such interruption cost money and can delay deliveries. You need quality that is respected for its skill and what works in practice, having them just add red tape and causing troubles for the ones reporting problems/deviations sets up a system where less and less is reported (we boys handle this ourselves…) and fixed without full documentation.

  9. Boeing seems to want to look at structure of the reporting system, rearranging the deck chairs on the Titanic. If Boeing was building a bridge using the same methodology, what would be the result? The culture needs to be changed, but, organizing work groups and the reporting chains of command, isn’t the way to achieve it.

    • Boing’s C-suite are working hard to Not Understand.
      One could argue that that’s what they’re paid to do, these days- though I won’t.

      If the powerful entities behind the scenes really wanted
      things at that company to be different, they would be different. The “we’re helpless! what do we do?” vibe
      in the media coverage of that company does not ring true..

      Ockham’s Razor suggests there might be
      something else going on there; something bigger
      than already-sizeable Boing.

      • I fully agree.

        Another way to put it is that the System not only encourages but rewards corruption, then that is what you are going to get.

        The reports in and of themselves will not solve this, but each one is a blow to what is going on and you will see Boeing throwing people under the plane until it gets to the top.

        Then we see if we get another Calhoun or a Mullally .

  10. Seems that the ODA issue which Leeham had a two part series on, is raising it’s ugly head again.

    Any recommendations in that report? Maybe for 3rd party over sight?

    • Its never stopped rearing its ugly head.

      Leeham endorsed a 3rd party as a Bridge.

      But that gets back to corruption. As long as the top management views Boeing as a way to get rich, then it will go no where.

      The very top has to believe in quality and safety and they have to ensure its adhered to down the entire management chain.

      I have seen the ultimate of forcing metrics to prove how great you are and the constant pressure on the employees to fake things so it appears to be true.

      Immediate issues can be reformed but its the big picture that will undermine it and the correction has to start at the very top including the board.

      A hint of the corruption is Walsh saying Boeing management is fine. Well its not and its grossly clear its not, but then the good old boy networks kicks in and things go downhill from there.

  11. All this report does is lay out parameters that Boeing is going to have to address before they are able to resume independent work again.

    Boeing is already on double secret probation. What I read is that until there is closure on the culture that allowed the production flaws to occur…Boeing will be told they are going to be on a short production leash. The Boeing president is encouraging its supply chain to continue production full blast. That is going to be a hard sell unless there is a tangible signal from the FAA that Boeing is allowed to resume its growth plan.

    The original Max shutdown was never supposed to last that long. It ended up at 20 months. Don’t be stunned if this probationary period lasts just as long.

    • The ramp up restriction to 38 was never intended to have any effect on Boeing and will be quietly removed when they actually reach that level.Just like the deferred prosecution agreement for the MAX will not result in a prosecution

  12. There is a bit of twisting involved. And I have less than no love for Calhoun, just to make that clear. But twisting things around to suit a view is wrong as well.

    There are contracts in place for the suppliers and as long as Boeing pays, then there is no reason the suppliers should throttle anything back and in fact could be held to account legally for not.

    The FAA has several areas in this its dealing with (their fault or not).

    Currently we have Boeing Renton and its production that is capped at a maximum of 38 (which it was not building).

    Within that the FAA is going to have to satisfy itself that the MAX is being produced per production certification standards and while not a declared slow down, that pace is going to be determined by its personal and inspectors ability to deal with that.

    I am not saying it will or will not result in a slow down but if its a consequence of slowing down production, that is on Boeing. Or it may wind up that the balance point is current production which is less than 38 a month.

    Everett is the other big issue. Boeing has to decide how much its going to spend on the MAX line there when the FAA is not going to approve its use for X period of time.

    How this all settles out will take 3-6 months to get an idea, but its not full steam ahead.

    The FAA does not like getting burned and it got burned.

    If Boeing is not seeing builds to the degree they have committed to suppliers to and for, then those contracts will get changed. Suppliers will be watching it and making their own decisions on ramping up (we are spending no money on that unless you give us money).

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