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Communication

The warning that didn't land

How to be heard by the person in charge · 14 min

In 1978 a crew circling Portland knew their fuel was running out, and said so. The plane still ran dry. Investigators found the warning was given, but softly. What pilots judged the words most likely to get through, and how to raise a concern so the person in charge hears it.

Takeaways

  • In the 1978 Portland crash, the crew did warn the captain about fuel; investigators found the warnings were subtle and named the failure to successfully communicate them as a contributing factor.
  • In a 1999 study of American airline pilots rating written scenarios, the ways of speaking judged most effective were neither the most direct nor the most indirect: "we need to", with the problem or goal attached.
  • This week: hold four pieces for one concern (what I see, why it matters, what we need to do, by when) and a second sentence ready if it's brushed aside.

Chapters

  1. Fifteen minutes0:17
  2. They did speak2:17
  3. We need to4:02
  4. Two ways to go unheard7:44
  5. Hear it done9:19
  6. Build yours10:46
  7. The answer12:16

References

  1. National Transportation Safety Board — Aircraft Accident Report: United Airlines, Inc., McDonnell-Douglas DC-8-61, N8082U, Portland, Oregon, December 28, 1978 (NTSB-AAR-79-7)(1979)
  2. Fischer, U., & Orasanu, J. — Say it again, Sam! Effective communication strategies to mitigate pilot error(1999)
  3. Milliken, F. J., Morrison, E. W., & Hewlin, P. F. — An exploratory study of employee silence: Issues that employees don't communicate upward and why(2003)
  4. Helmreich, R. L., Merritt, A. C., & Wilhelm, J. A. — The evolution of Crew Resource Management training in commercial aviation(1999)
  5. Salas, E., Wilson, K. A., Burke, C. S., & Wightman, D. C. — Does crew resource management training work? An update, an extension, and some critical needs(2006)
  6. Neily, J., Mills, P. D., Young-Xu, Y., et al. — Association between implementation of a medical team training program and surgical mortality(2010)
  7. Agency for Healthcare Research and Quality — TeamSTEPPS Pocket Guide; CUS tool(2020)
  8. Haynes, A. C. — The crash of United Flight 232 (talk at NASA Ames-Dryden Flight Research Facility)(1991)
  9. Federal Aviation Administration — Lessons Learned: United Airlines Flight 232, McDonnell Douglas DC-10-10, N1819U