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on 18 April 1999
As I read this book I found myself drawing relationships between the events of the Challenger disaster, and some technical projects I have worked on. Fortunately I have never work on a project that has suffered the type of cataclysmic failure that happened to the Challenger, however I have seen the same type of interaction between the "techies" and management. I have heard (almost verbatim) the same conversations that the engineers had in this book when faced with potentially dangerous problems and pressing deadlines. Anybody who works in very complicated disciplines knows that the explosion was not the disaster, but the culmination of a flawed process.
If you manage, or are involved in a technical process I would encourage you to read this book. It is a good case study of how subtly the seeds for a disaster can be planted. Although dry and tedious at times to read it is worth the effort.
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on 1 April 1999
Should be read by all people who make decisions. Explains how well educated people can discommunicate when under pressure and make decisions that risk lives. Also explains how logical thought can be severely missused to justify actions. Shows how cost, schedule and performance trade-offs are made. Frequently 'senior management' are driven by cost and schedule and engineers are put in the position of proving that performance failure will result. The sad thing with this particular case is that the necessary information was available BEFORE THE LAUNCH and a gamble was taken.
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on 6 June 2000
Be warned -- this book is not an easy read! This is an outstanding book on the culture of decision making and not a simple de-layering of what happened to Challenger. It is painstaking, revelatory and thorough -- and probably should be required reading for all those whose actions commit others to hazardous events.
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on 21 February 1999
A great book - many lessons for business in making decisions based on what you want to see and not what is really in front of you.
The actual cause of the disaster is clear in the first 20 of 500 pages - the booster O ring was safe at perhaps 60F while the booster had been only 8F some two hours before the launch, the ambient temperature was less important as the booster that failed was not in the direct sunlight.
The other 480 pages try to explain why rational people relied on "gut feel" when any non engineer could see that all the available evidence was that the seal would fail - this time or next time but eventually - and sooner rather than later.
Well researched and well converted into low level technical language for non engineers.
Worth reading when you want to be reassured that standing up for what you believe is right in large organisations is a worthy cause.
The only question not asked - would those who made the launch decision traded places with the crew.
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on 8 February 1996
This book reviews in great detail the processes that went into
(and predated) the decision to launch the space shuttle Challenger.
It takes a potentially "new" view of this decision, namely
outlining how the problem wasn't 'a few bad managers willing
to explicitly sacrifice safety for the sake of getting this
particular shuttle off the pad' {my words}. Instead, the
problem was an entire culture, at NASA, at Morton Thiokol, and
in the country as a whole, that emphasized the production
schedule, normalized deviance (i.e. rationalized the aberrant
behavior of the O-rings in the joints of the booster), and
constructed the "risk assessment" to suit a wide variety of needs.

This book will join the shelf with a very few other works on
decision making in high-hazard environments, particularly Perrow's
NORMAL ACCIDENTS, and Scott Sagan's LIMITS OF SAFETY.
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on 10 September 2014
Bought this as part of my Criminology degree and investigation into the shortcomings of some organisations in making appropriate decisions. A great read- very thorough.
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on 8 June 2008
This is the book that in 1998 convinced me to change from a career in aviation design to one in avation safety. Vaughan suprised herself when a study into anticipated management wrongdoing became a safety study. Sometimes hard going but a rewarding read with 3 powerful concepts emerging.
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on 13 January 2016
A book with ideas totally relevant to today, tomorrow and the day after.
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on 24 July 2000
Imagine your safe white-collar decision making process applied to the launch of an incredibly complex machine such as the Shuttle.Imagine applying the concept of `Well it worked last time' applied to a phenomonally complex piece of physics such as the Shuttle.
When most of us make a mistake it costs our employer a couple of hundreds of dollars. Imagine gambling with lives as you weigh up the worth of lives versus economics.
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on 23 July 2014
Great book.
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