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Volume 18: Number 2: Article 1
Analysis of the Columbia Shuttle Disaster: Anatomy of a Flawed Investigation in a Pathological Organization
John P. MacLean with Gordon Campbell and Scott Seals, Utah Valley State College, Orem, Utah
Ten days after the Columbia shuttle disaster, the members of two of my classes were assembled to do an analysis of the event. One of the classes was studying Creative Problem Solving and the other Incident Investigation. The shuttle disaster provided an opportunity to relate our studies to a current real-world event. The excitement and energy in the two sessions was phenomenal, and the depth and quality of information brought to the sessions was amazing for undergraduate researchers. It was obvious that our findings were not the same as those of the National Aeronautics and Space Administration (NASA). Their scenario, almost uninterrupted since the disaster, has focused on a block of foam insulation that came loose from the HydrogenOxygen vessel and impacted the leading edge of the left wing of the shuttle. Their contention is that this breached the integrity of the left wing and allowed hot gases to enter on re-entry and destroy the wing. We will show that this scenario does not fit the data well and gives inordinate weight to suspect data and to ground testing that does not duplicate the lift-off conditions. We will present a different scenario that includes structural failures inside the wing on lift-off which fits all of the evidence available to us, including the information presented in the official Columbia Accident Investigation Board (CAIB). The action items for this much more likely scenario are very different than those proposed in the NASA conclusions. We will discuss the cultural, organizational, and management characteristics of the NASA organization and their impact in the flawed investigation of the Columbia shuttle disaster.
Keywords: accidents, organizations, organizational culture, cover-ups, NASA, Columbia, bad science
FULL TEXT:
Analysis of the Columbia Shuttle Disaster: Anatomy of a Flawed Investigation in a Pathological Organization
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