Introduction

Summary

On January 28, 1986, the American shuttle orbiter Challenger broke up 73

seconds after liftoff, bringing a devastating end to the spacecrafts 10th
mission. The disaster claimed the lives of all seven astronauts aboard,
including Christa McAuliffe, a teacher from New Hampshire who had been
selected to join the mission and teach lessons from space to
schoolchildren around the country. It was later determined that two rubber
O-rings, which had been designed to separate the sections of the rocket
booster, had failed due to cold temperatures on the morning of the
launch. The tragedy and its aftermath received extensive media coverage
and prompted NASA to temporarily suspend all shuttle missions
[ CITATION Ian09 \l 1033 ]

The Rogers Commission also investigated and revealed that there is a lot
of internal working of NASA and it was geographically dispersed matrix
organization. Other than that the commission also concluded that NASA
was working with an unrealistic schedule for flight.

After The Challenger Disaster, The Commissions recommendation

includes that NASA restructure its management to tighten control, set up
a group to finding and tracking hazards in regard of shuttle safety and
review the critical items as well as submitting its redesign of the booster
joint, [ CITATION His16 \l 1033 ]

On Feb. 1, 2003, space shuttle Columbia broke up as it returned to Earth,

killing the seven astronauts on board. NASA suspended space shuttle
flights for more than two years as it investigated the disaster.

An investigation board determined that a large piece of foam fell from the
shuttle's external tank and fatally breached the spacecraft wing. This
problem with foam had been known for years, and NASA came under
intense scrutiny in Congress and in the media for allowing the situation to
continue.
Question 1

What aspect of NASA practise revealed in the aftermath of the Columbia Disaster suggests
that the challenges sought in the aftermath of the Challenger Disaster were not sustained?

The changes sought in the aftermath of the Challenger Disaster were not sustained is
ineffective leadership in the organization of NASA is they failed to fulfill the implicit
contract to do whatever is possible to ensure the safety of the crew, [ CITATION Shu03 \l
1033 ]. The manager of NASA is failed to understanding the real problem and its implication
what might be happen. They preferred stating the preconceived conclusions based on
subjective knowledge rather than on solid data. They also tend to fulfil goals where per year it
should be 24 shuttle to be launched and this happen when the Manager of NASA resist to
launch the Challenger even though the engineer advice not to do so. It is due to bad weather
during that day which more cold rather than other day and the engineer advise to delay it for a
few hours or might be a day but the management of NASA expressed their frustration and the
launch still go on. Same goes with Columbia when the management of NASA just overridden
the thing that requested by engineer of NASA to reviewing the launch videos without any
hearing. It shown here the organization in NASA did not take the previous accident as guide
to reduce the potential of accident and just simply take an action without further research.
Because of these repeating patterns that practises embedded in NASA it might be substantial
contribution to both accidents. Both accidents happen because the manager of NASA fails to
fulfill the entire requirement that needed to ensure the safety of the crew. It clearly shown
here the actions taken by the manager NASA are very important and they should be really
carefully when deciding on something that related to human lives. If this matter did not take
seriously it could became danger towards safety of the crew.
 Moreover the changes that were not sustained is because the manager of NASA fell
into the habit of accepting as normal some flaws in the shuttle system and tend to ignored or
recognized that these problem could lead to accident,[ CITATION Shu03 \l 1033 ]. The cause
of the disaster is also because of the physical of shuttle itself which manager fail to review on
the critical items that lead to the accident. In case Columbia, the disaster happen because of
the physical of the shuttle when a1.67 pound slab insulating foam fell off the external fuel
tank and then hit the left wing and breached in the tiles designed to protect the aluminum
wing from the heat of reentry. On reentry, the breach allowed superheated gas into the wing,
which, as a result, melted in critical areas. This thing can be actually a small lacking in the
shuttle system but because of that thing hit on the critical areas it became dangerous and
possibility the shuttle can explode. The external tank of the shuttle actually was designed with
a layer of insulation tiles that were designed to stick with the tank, not to be shed. The
shuttles heat shield designation made was not to be damaged and the tile also isnt allowed to
fly in rain or stay outside when it hails. The layer of tiles can fell off from the external tank
because of the weather and sometimes damaged same goes with this accident,[ CITATION
IAN08 \l 1033 ]. This matter had occur so many time and tiles had damaged almost all the
time but the Manager of NASA did not take this as a serious and just convinced themselves
there was no safety-off-flight issue.

Same goes with the Challenger, the main cause of the accident is also because of the
shuttle which had problem with the synthetic rubber O-rings. Synthetic rubber O-rings were
designed to keep the rockets superhot escaping from the joints between the boosters four
segments. This O-ring erosion previously had caused so many problems but still there was no
action taken. The days before the scheduled launch the temperature as low as 18 degree
fahrenheit and the expert, Roger Boisjoly requested to delay the it until reachable the suitable
temperature. However after the meeting and discussion manager NASA still come out with
solution to launch it which finally resulted the disaster because of the cold temperature on
that day,[ CITATION IAN08 \l 1033 ] It also had been called as launch rush on that day
which became the biggest mistake of NASA and had been suspended for 2 years,
[ CITATION Eli03 \l 1033 ] From this it shows that there is no sustain in the changes that
made by NASA as promised as the problem came from the shuttle itself.

Last but not least the changes that were not sustained after the tragedy of Challenger
Disaster are the organizational barriers which prevented effective communication of critical
safety information. In the organization the manager of NASA is encouraged a silence mood
among their employees. And if anyone interested in safety must take steps in guarantee that
all relevant information is presented to decision makers. When the information is not reveal
to all the employees they do not know what is the actually accident that might happen in the
future. Pursuant to this case it happen in Columbia mission when the engineer of Rodney
Rochas email to asking Johnson Space Centre about if the crew had been directed to inspect
Columbias left wing had been left answered. It shown here the communication among them
is not effective and unfortunately these things lead to the accident. Regarding Challenger,
engineer at SRB contract wanted to postpone the launch of the shuttle for the few hour or for
a day due to weather and were heard by company management in last-minute readiness-to-
launch reviews, but then NASA official expressed frustration and desire to launch. Because
of the warmer weather it became the one of reason for the shuttle towards disaster. With
respect to Columbia, because the impact seemed more significant than the many previous
instances of foam striking so the engineer of NASA reviewing the launch videos was
alarmed. They requested for management to check it but were overridden by management
without a hearing. It show the communication is actually does not give effect toward the
management of NASA when they just simply take it simple. The engineer also did not push
their arguments towards the organization because of fear for losing their careers. Therefore
they just deciding to agree with the idea to launch the shuttle and just accepted the risk and
damaged that might happen.
Question 2

This chapter provides a discussion of actions that can be taken to sustain change. Which of
the following do you see as most applicable to addressing the situation described in this case?

Redesign roles

Redesign reward system

Link selection decisions to change objectives

Act consistently with advocated actions

Encourage voluntary acts of initiative

Measure progress

Celebrate en route

Fine-tune

Answer

The most applicable to addressing the situation described in this case are act
consistently with advocated actions, encourage voluntary acts of initiative and measure
progress. The first is act consistently with advocated actions. This indicates the permanency
of change through adopted practices and priorities or walks the talk. This means the
organization's need to prove their act with an action or represent their words with action to
shows that they're really means to it and not just words. Regarding to this case, after the
Challenger accident, NASA has acted to elevate agency emphasis on safety and implement
organizational changes to strengthen Safety, Reliability, Management (SRM) and Quality
Assurance (QA) programs and they has formed the Columbia Accident Investigation Board
(CAIB) to identify what had happened,[ CITATION IAN08 \l 1033 ]. Unfortunately, even
NASA has undergone many management reforms in the wake of the Challenger accident,
they still preferred stating the preconceived conclusions based on subjective knowledge
rather than on solid data. NASA also does not take examination of risk seriously and does not
fully understand the system. Even they said that they have a strong safety culture, but in fact
they did not take the previous accident as guide to reduce the potential of accident and just
simply take an action without further research. It can be seen when both of the accidents
happen because of the manager of NASA fails to fulfill the entire requirement that needed to
ensure the safety of the crew. Moreover, after the Challenger accident, NASA managers said
that their staffs were encouraged to identify about the safety issues and they bring these to the
attention of the management; however there was evidence contrary which can be seen before
the Columbia accident happened where NASA engineers requested a damage assessment but
they were overridden by management without a hearing. If the management honour the
request, the disaster might have been prevented. This shown that NASA did not prove their
act to elevate agency emphasis on SRM and QA programs with their action as they did not
performs it.

Next is encourage voluntary acts of initiative. This means the new practices that
support the change should be encouraged as the norm at all levels of the organization. To
encourage voluntary acts of initiative, the organizations should let everybody in the
organization to contribute their opinion. Pursuant to this case, NASA managers do not taking
steps to ensure that minority and dissenting voices were heard. When this happened, the
manager of NASA is failed to understanding the real problem and its implication what might
be happen. During the post-challenger change in NASA, the Commissions has make a
recommendations included that NASA restructure its management to tighten control, set up a
group dedicated to finding and tracking hazards in regard to shuttle safety, and review its
critical items as well as submitting its redesign of booster joint to a National Academy of
Sciences group for verification but NASA managers was prevent the effective communication
in their organization that make them did not support the new recommendations for a changes.
From this case, it shows that the engineers did not push their arguments because of fear for
their careers. They must accept the risks and deciding to launch the shuttle and make damage
to seals and strikes by foam were no longer an issue which they did not take it as serious
problem that will lead to the next accident,[ CITATION Rad05 \l 1033 ] Furthermore, there
was an unofficial hierarchy among NASA programs and directorates that hindered the flow of
communication when management decisions during Columbias final flight reflect missed
opportunities, blocked or ineffective communication channels, flawed analysis and
ineffective leadership. The most striking is the fact that management displayed no interest in
understanding a problem and its implications. Because the managers failed to avail
themselves of the wide range of expertise and opinion necessary to achieve the best answer to
the debris strike question, some Space Shuttle Program managers failed to fulfil the implicit
contract to do whatever is possible to ensure the safety of the crew. In fact, their management
techniques unknowingly imposed barriers that kept at bay both engineering concerns and
dissenting views, and ultimately helped create blind spot that prevented them from seeing
the danger the foam strike posed. From this case, NASA managers do not encouraging
voluntary acts of initiative in their management when they did not want to hear their
employees voice that makes them do not support the new practices for changes and do not
encourage it in all level of organization.

Lastly is measure progress. Measures are used as a means to quantify the progress of
change and to provide achievable goals. Pursuant to this case, in balancing the safety and
performance of the shuttle's design, it represents NASA's understanding of the system and
predicts that the shuttle's flight will safely meet performance requirements. To count as a
success, a shuttle flight must perform as the design predicts, not merely return "safely" to
Earth. However, the 2003 Columbia disaster report quotes the 1986 Challenger report to
show that the causes were identical which there was evidence that the shuttle did not
performed as designed and because of no improvement in the level of NASA funding, NASA
Administrator, Daniel Goldin pushed a Faster, Better, Cheaper program that impacted on
the shuttle program. Moreover, NASA fell into the habit of accepting as normal some flaws in
the shuttle system and tend to ignored or recognized that these problem could lead to
accident. The cause of the disaster is also because of the physical of shuttle itself which
manager fail to review on the critical items that lead to the accident. It can be seen at the
physical of the shuttle where the external tank of the shuttle actually was designed with a
layer of insulation tiles that were designed to stick with the tank, not to be shed. The shuttles
heat shield designation made was not to be damaged and the tile also isnt allowed to fly in
rain or stay outside when it hails. The layer of tiles can fell off from the external tank because
of the weather and sometimes damaged same goes with this accident,[ CITATION IAN08 \l
1033 ]. This matter had occur so many time and tiles had damaged almost all the time but the
manager of NASA did not take this as a serious and just convinced themselves there was no
safety-off-flight issue. It shows that NASA does not make a proper measure progress from
the Challenger accident as they do not make an improvement in the design of the shuttle.
Bibliography
Shuttle report blame Nasa Culture. (2003, August 26). Retrieved from NBC News.com:
http://www.nbcnews.com/id/3077541/ns/technology_and_science-space/t/shuttle-report-
blames-nasa-culture/#.VwJibPl97tT

Howell, E. (2003, Feb 1). Columbia Disaster; what happened, what NASA learned. Retrieved from
Space.com: http://www.space.com/19436-columbia-disaster.html

IAN PALMER, R. D. (2008). Managing Organizational Change. UNITED STATEs: Mc GRAW.HILL

INTERNATIONAL EDITION.

Radford Byerly, J. (2005). Space Shuttles Challenger and Columbia Accidents. Retrieved from Gale
Global Issues in Context: http://find.galegroup.com/gic/infomark.do?
&idigest=fb720fd31d9036c1ed2d1f3a0500fcc2&type=retrieve&tabID=T001&prodId=GIC&do
cId=CX3434900645&source=gale&userGroupName=itsbtrial&version=1.0