NASA Takes Giant Leap Toward a Change in the Safety Culture

June 1, 2004
The image is one few Americans will forget: the sight of the Space Shuttle Columbia exploding, its pieces falling back to earth in a blazing shower. When a report by the Columbia Accident Investigation Board (CAIB) revealed that the safety culture at NASA was a contributing factor, the agency began exploring its options.

Since the release of the CAIB report in August, NASA leadership says it was inundated with suggestions and advice on how to guide NASA through the cultural changes indicated in the board's findings. Speaking to reporters late last year, NASA Administrator Sean O'Keefe said that he was warned by colleagues to be on guard against "charlatans and flimflam artists" masquerading as consultants.

After a competitive procurement process that included more than 40 potential providers, NASA selected Behavioral Science Technology Inc.

According to BST Chief Executive Officer C. Patrick Smith, BST's use of performance improvement and organizational development tools derived from the applied behavioral sciences is a significant departure from the "train and hope" approach frequently associated with culture change efforts. Other organizations that have contracted BST services include the United States Marines Corps, Genentech, GlaxoSmithKline, Los Alamos National Laboratory, and Lockheed Martin Missiles & Space Co.

In communications to employees, NASA leaders have emphasized that the BST-led culture change effort will be the integration point for all other organizational culture efforts related to the CAIB recommendations, including OneNASA, Return-to-Flight and the Diaz Implementation.

"The successful implementation of this effort is critical to the agency's future as we prepare to return to flight and implement the president's vision for U.S. space exploration," said NASA Associate Deputy Administrator James Jennings, in a February memo.

The NASA culture change initiative was kicked off in March using a proprietary BST survey to conduct an agency-wide cultural assessment. Results are published on NASA's Web site ( Among the conclusions, the report noted that safety culture remained a problem more than a year after the Columbia disaster.

"Safety is something to which NASA personnel are strongly committed in concept, but NASA has not yet created a culture that is fully supportive of safety,'' the report states.

But the news isn't all bad. "We're building on a very solid foundation," Smith notes. "People choose to work at NASA because they have a passion for the agency's mission they want to contribute to the President's vision for space exploration. They have an intense achievement orientation an amazing can-do attitude."

Where they get into trouble, Smith says, is in balancing risk and achievement. "Their achievement drive is both a great strength and, if unmanaged, a very real liability."

In order to improve the agency's safety culture without compromising its strengths, the culture change effort will include behavior-based leadership development, cognitive bias training, and comprehensive team and individual effectiveness processes. The initiative will engage NASA employees from the agency's lowest levels to supervisory staff and upper-level management.

The core of the change effort will involve BST helping NASA personnel to identify the behaviors critical to successful outcomes and implementing mechanisms that systematically capture data on the occurrence of these behaviors. These efforts will be followed up with data-driven interventions that root out organizational barriers and help individuals adapt to safety expectations. "Changing an organizational culture is a tricky business. The change comes down to very specific sets of behaviors, mostly related to leadership," says Thomas Krause, BST chairman.

Speaking to business leaders earlier this year, NASA Administrator Sean O'Keefe emphasized that addressing culture was part of the agency's promise to the Columbia astronauts' families and the American people. "We are working hard to fulfill our pledge. We take seriously our commitment to implement all of the Columbia Accident Investigation Board's recommendations for addressing the technical, organizational and human factors that contributed to the accident. We are also striving to raise the safety bar even higher."

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