Manual No.

: JCI-13

Jade Cargo International Co. Ltd. Crew Resource Management MANUAL (January 2008) Revision Status: Original

Approved By Flight Crew Training Section

Acknowledgement and credit for most of the content of this manual is hereby given to Emirates and SAA

Page: TOC-1

CRM Manual

Date: January 2008

Table of Contents 1 CRM Training................................................................................................... 4 1.1 Introduction............................................................................................. 4 1.2 Courses...................................................................................................4 1.2.1 CRM Introduction Course.............................................................. 4 1.2.2 CRM Indoctrination Course........................................................... 4 1.2.3 CRM Update Course..................................................................... 4 1.2.4 CRM Recurrent Training................................................................5 1.2.5 CRM Upgrade Training..................................................................5 1.2.6 CRM Transition CRM.................................................................... 5 2 Modules Content.............................................................................................. 5 2.1 Threat and Error Management............................................................... 5 2.2 Culture.................................................................................................... 5 2.3 Automation.............................................................................................. 5 2.4 Leadership, Followership & Team Dynamics......................................... 6 2.5 Communication (Communication Styles & Conflict Resolution)............. 6 2.6 Problem-Solving & Decision Making.......................................................6 2.7 Cognition................................................................................................. 6 2.8 Stress & Alertness Management............................................................ 6 2.9 Situational Awareness............................................................................ 6 3 Threat and Error Management.........................................................................7 3.1 Introduction............................................................................................. 7 3.2 CRM Training in Aviation........................................................................ 7 3.3 Human Performance...............................................................................7 3.4 Evolution of CRM.................................................................................... 8 3.5 Human Error........................................................................................... 8 3.6 Human Factors In Design....................................................................... 8 3.7 The Error Chain...................................................................................... 9 3.8 Swiss Cheese......................................................................................... 9 3.9 Threat and Error Management............................................................. 10 3.10 Threat and Error..................................................................................10 3.11 Warning Flags.....................................................................................11 3.12 Avoid, Trap, Mitigate........................................................................... 11 4 Culture............................................................................................................12 4.1 Introduction........................................................................................... 12 4.2 National Culture.................................................................................... 12 4.3 Individualism/Collectivism (IDV)........................................................... 12 4.4 Effects on Crew Behaviors................................................................... 12 4.5 Uncertainty Avoidance (UA)................................................................. 13 4.6 Power Distance (PDI)........................................................................... 13 4.7 Organizational and Professional Culture.............................................. 14 5 Automation..................................................................................................... 14 5.1 Introduction........................................................................................... 14 5.2 Flight Deck Automation.........................................................................14 5.3 What to Automate................................................................................. 15 5.4 Fitts’ List................................................................................................ 16 5.5 The Automation Pyramid...................................................................... 17 5.6 The Irony of Automation....................................................................... 18

Page: TOC-3

CRM Manual

Date: January 2008

5.7 The Automation Issue........................................................................... 18 5.8 Interfaces.............................................................................................. 18 5.9 Feedback.............................................................................................. 19 5.10 From an Aircraft Manufacturer............................................................ 19 5.11 Ergonomic Design Principles.............................................................. 19 5.12 Conclusion.......................................................................................... 20 6 Leadership and Team Dynamics................................................................... 20 6.1 Introduction........................................................................................... 20 6.2 Leadership............................................................................................ 20 6.3 Leadership Theory................................................................................ 21 6.4 Action-Centred Leadership................................................................... 21 6.5 Task...................................................................................................... 22 6.6 Team Building and Maintenance.......................................................... 22 6.7 Individual Development and Satisfaction.............................................. 22 6.8 The Role of Leader............................................................................... 22 6.8.1 Regulating Information Flow........................................................ 22 6.8.2 Directing and Coordinating Crew Activities................................. 23 6.8.3 Motivating Crew Members........................................................... 23 6.8.4 Leadership Styles........................................................................ 23 6.9 Cockpit Authority Gradient.................................................................... 25 6.10 Followership........................................................................................25 6.11 Team Dynamics.................................................................................. 26 7 Communication.............................................................................................. 27 7.1 Introduction........................................................................................... 27 7.2 Principles of Communication................................................................ 27 7.3 Communication Barriers....................................................................... 27 7.4 Communication Styles.......................................................................... 28 7.4.1 Assertive Behavior [a1]................................................................28 7.4.2 Aggressive Behavior [a2].............................................................29 7.4.3 Supportive Behavior [s1]............................................................. 29 7.4.4 Submissive Behavior [s2]............................................................ 29 7.5 Dealing with Aggression....................................................................... 30 7.6 Conflict Resolution................................................................................ 31 7.7 Problem Solving....................................................................................31 7.8 Compromising....................................................................................... 31 8 Problem Solving and Decision Making.......................................................... 32 8.1 Introduction........................................................................................... 32 8.2 Structured Decision Making.................................................................. 32 8.2.1 The Model “Footprint”.................................................................. 33 8.2.2 Providing “Seamless Integration”................................................ 33 8.3 A Problem-Solving Model..................................................................... 34 8.4 Time Management................................................................................ 35 8.5 The Jade Cargo International Decision-Making Model.........................36 8.6 Assess.................................................................................................. 37 8.7 Action.................................................................................................... 37 8.8 Manage................................................................................................. 37 9 Cognition........................................................................................................ 38 9.1 Introduction........................................................................................... 38 9.2 Models.................................................................................................. 38
Flight Crew Training Centre

Page: TOC-3

CRM Manual

Date: January 2008

9.3 A Model of the Cognitive Brain............................................................. 38 9.4 Input functions.......................................................................................39 9.4.1 Senses.........................................................................................39 9.4.2 Attention.......................................................................................39 9.4.3 Divided Attention......................................................................... 39 9.5 Perception............................................................................................. 39 9.6 Processing Functions........................................................................... 40 9.6.1 Memory........................................................................................40 9.6.2 Sensory Memory......................................................................... 40 9.6.3 Short-Term Memory.................................................................... 40 9.6.4 Long-Term Memory..................................................................... 41 9.6.5 Flashbulb Memory....................................................................... 41 9.6.6 Central Processor/Decision-Maker.............................................. 42 9.6.7 Problems with Decision Making...................................................42 9.7 Conclusion............................................................................................ 43 10 Stress and Alertness.................................................................................... 43 10.1 Introduction......................................................................................... 43 10.2 Stress.................................................................................................. 44 10.3 Types of Stress................................................................................... 44 10.3.1 Acute Stress.............................................................................. 44 10.3.2 Episodic Acute Stress................................................................45 10.3.3 Chronic Stress........................................................................... 46 10.3.4 Sources of Stress...................................................................... 46 10.3.5 Life Stress..................................................................................46 10.3.6 Environmental Stress................................................................ 47 10.3.7 Cognitive Stress........................................................................ 47 10.4 Alertness............................................................................................. 48 10.5 Sleep Management.............................................................................48 10.6 Circadian Rhythms..............................................................................49 10.7 Stress and Alertness Management.....................................................50 10.8 Controlled Rest in the Flight Deck...................................................... 50 11 Situational Awareness..................................................................................50 11.1 Introduction......................................................................................... 50 11.2 Levels of Situation Awareness (SA)................................................... 50 11.3 Loss of Situational Awareness............................................................51 11.4 The Safety Window.............................................................................52 11.5 Situational Awareness and Error Management.................................. 53 11.6 Factors Affecting Situational Awareness............................................ 53 11.7 Communication and Shared Situational Awareness.......................... 53 11.8 Techniques for Better Situational Awareness Management...............54 12 Reference Notes.......................................................................................... 55

Flight Crew Training Centre

Page: 4

CRM Manual

Date: January 2008

1 CRM Training
1.1 Introduction
CRM training will be provided to all Jade Cargo International pilots in accordance with the policy contained within the Flight Operations Manual. CRM training provided to Jade Cargo International pilots is based on the requirements of the Chinese Civil Aviation Regulations (CAAC) and also meets the requirements of other regulatory bodies.

1.2 Courses 1.2.1 CRM Introduction Course
The Jade Cargo International CRM Introduction Course is a “CAAC” approved course conducted by Jade Cargo International staff. The course is not assessable. The Initial Course will be applied to all new pilots upon entry to Jade Cargo International. It is designed to introduce pilots who have received prior Human Performance training with other airlines to the concepts in use at Jade Cargo International. The required time is prior to transition training. It is designed to be complementary to the Transition Course (see below). The duration of the course is one day.

1.2.2 CRM Indoctrination Course
The Jade Cargo International CRM Indoctrination Course is a “CAAC” approved course conducted by Jade Cargo International staff. The course is not assessable. Most pilots joining Jade Cargo International will have completed Human Performance training as part of their license requirements; however CRM is viewed as specific to the airline. Therefore, the purpose of this course is to deliver Jade Cargo International perspective on CRM, expanding on the introductory course that has already been completed. The duration of the course is two days and is designed to be applied in isolation. The award of a Certificate of Completion and registration with Crew Records signifies successful completion of a course.

1.2.3 CRM Update Course
Jade Cargo International designates a three-year training cycle for CRM. This cycle is deemed to begin when a pilot completes his transition training with Jade Cargo International. To revalidate a pilot’s CRM training at the end of the cycle, a one day update course is conducted.
Flight Crew Training Centre

4 CRM Recurrent Training Jade Cargo International pilots receive a recurrent CRM component as part of the recurrent training package approved by the (CAAC). The course is tailored to suit the specific requirements of each aircraft type. The content of this CRM component is designed by the Head of Training in co-ordination with the CRM Instructor. and team management skills. 1. They will be conducted in a cockpit environment and videotaped where appropriate for debriefing purposes. assisted by the facilitator. 2 Modules Content 2. 1.2.1 Threat and Error Management       Nature of human performance & error A model of human error Threat and error defined Latent threats Defenses Managing error 2.2 Culture     The characteristics of National culture Influence of Professional & Organizational culture Defenses against multi-cultural threats Safety culture within Jade Cargo International 2.Page: 5 CRM Manual Date: January 2008 1.5 CRM Upgrade Training Jade Cargo International requires all candidates for Command training to receive an intensive CRM course. The course consists of a review of decisionmaking. The role-plays are designed to allow upgrade candidates to use the decisionmaking tools. leadership and team management. and a series of role-plays.2. The candidates will conduct their own debrief.3 Automation   Impact of automation Appropriate use of automation Flight Crew Training Centre . This will be delivered during the ground school phase.6 CRM Transition CRM Jade Cargo International includes a CRM component in all type transition courses.2. This has proven to be a powerful tool to reinforce the learning process.

Followership & Team Dynamics     Command authority Leadership styles Team effectiveness Reference accidents with leadership issues 2.7 Cognition      Overview of cognitive functions Perception Senses Memory Limitations 2.8 Stress & Alertness Management    Types and sources of stress Fatigue & sleep management Jade Cargo International policy and procedures 2.Page: 6 CRM Manual Date: January 2008  Reference accidents with automation issues 2.6 Problem-Solving & Decision Making     Problem identification Time management Company decision-making tool Reference accidents with decision-making issues 2.9 Situational Awareness     Types of situational awareness Skills affecting individual situational awareness Loss of situational awareness Reference accidents with situational awareness issues Flight Crew Training Centre .4 Leadership.5 Communication (Communication Styles & Conflict Resolution)     Model for effective communication Source of Conflict Communication role-play Reference accidents with communication issues 2.

Every airline has the anecdotal CRM immune Captain. to the amount of air recirculation that is required in a pressurized aircraft. to the brightness required of an electronic display.2 CRM Training in Aviation The relationship between Human Factors. skill and attitude. whereas CRM is focused at the level of the individual airline and is normally a customized program. HPL. Despite improvements in technology. because it encompasses all other areas of the discipline. completion of a Multi-Crew Co-ordination (MCC) course prior to airline employment and for an airline to run an approved Crew Resource Management (CRM) program for all phases of training. This is due. Regulators and industry have sought to reduce the human effect by the introduction of non-technical training to address the human issues. 3. Threat and error management is at the core of current CRM practice. The safe and efficient management of an aircraft requires a balance of both technical knowledge and skills. This is a general overview and broadly theoretical. Traditionally the focus of CRM has been on attitude. Human Performance and Limitations refers to those aspects that relate to human involvement in aircraft operations.Page: 7 CRM Manual Date: January 2008 3 Threat and Error Management 3. Regulators require knowledge of Human Performance and Limitations (HPL) for license issue. design and engine reliability. This includes everything from the design of a tool. MCC starts to cover the practicalities of multi-crew operations. Human Factors or ergonomics is the broad science that covers human interaction in the workplace. Flight Crew Training Centre .1 Introduction Investigation of commercial airline accidents has identified that a significant proportion of these are due in some way to a human element. to the design of a checklist. in part. which has typically resulted in only temporary changes in behavior and is not universally accepted by the pilot population. Human Factors still have a critical influence on the accident rate.3 Human Performance Human performance can be considered as falling into three categories. knowledge. 3. MCC and CRM is most easily described as one of specialization. home. who complains that it is all a waste of time and does not apply to him. with an understanding of the limitations of the human operator. environment. and with other humans.

which cannot be tolerated in the aviation industry. focus on specific skills 4th Fourth Generation developed alongside the introduction of Advanced Qualification Program (AQP) and LOFT 5th Fifth Generation introduced the concept of error management This has now evolved into “threat and error” management. J.6 Human Factors In Design The principle need for Human Factors in design is to account for individual differences and to produce a system that is better matched to real human performance. Most of these errors are small. Current CRM thinking focuses on training knowledge and skills.5 Human Error Reason (Reason. encompassing the best of previous generations. Human Error) has developed a model of human error that classifies these according to the circumstances under which they occur. but pilots are predisposed to accept knowledge and tools with which to improve performance. Violations refer to intentional noncompliance. and humans have good error-correcting mechanisms to mitigate the effects of these errors. Errors are defined as unintentional deviations from required behavior and are to be expected in everyday life with unavoidable regularity. Not only is this more predictable and measurable. 3. In particular this means designing for error. 3. 3. Reason is the acknowledged expert on human error. especially on a long. but avoiding the trap of undue emphasis on attitudes. Error cannot be avoided so the design must ensure that the most serious mistakes are prevented by trapping mechanisms and clearly forewarned by use of appropriate and timely feedback.Page: 8 CRM Manual Date: January 2008 It is now recognized that attitudes are difficult to change. with aviation focus (Crew RM) 3rd Generation attempt at integration with technical training.term basis in the presence of contradictory influences. Flight Crew Training Centre . 1990.4 Evolution of CRM      1st Generation concentrated on attitudes and personal management style (Cockpit RM) 2nd Generation introduction of modular training.

Others were management failures. occurring years ago on the drawing board. of which the operating crew are the last link. leaving an opening in the defensive wall and allowing an accident to happen. some of the factors were as follows:         Lengthened 737-400 entered service requiring increased thrust Existing engines approved for higher thrust without flight-test Type certification granted Operator differences training approved Fleet operated with mix of different style engine instruments Significance of other operator’s engine defects not identified Engine malfunction during accident flight Incorrect identification of engine malfunction All of these factors were required for the accident to take place. Reason used Swiss cheese. Reason has likened the multiple layers of defenses to slices of cheese. the British Midland 737-400 that crashed in 1989 was a classic example of an error chain. Without assigning a principle cause. the last line of defense. The holes in the cheese are the flaws that exist in each individual layer of defense. a combined layer of defenses that can act as an effective shield. In isolation it is insignificant. Rather. This does not mean that accidents can no longer occur.7 The Error Chain The introduction of automated systems has made it virtually impossible for a frontline operator to cause an accident in isolation. existing conditions that might remain dormant for years. possibly as early as the design stage of a product. It was but it is not an isolated case. For example. the holes will line up. but placed together they form a robust wall. If they can break the chain. Some were latent failures. The accident is caused by the completion of a chain of events – the “error chain”. A simple example of a latent threat is a mousetrap. but when the mouse tries to take the bait. In order to illustrate better the concept of latent threats. 3. Occasionally. These are what Reason call “latent threats”. Accident investigation has therefore become much more complex with additional factors to consider. There are similar events unfolding all around us in aviation. The crew was the last chance of avoiding this accident. that the causes of most recent accidents have been found to be omissions or errors that occurred remotely from the operator who suffered the loss. the accident does not occur.Page: 9 CRM Manual Date: January 2008 3. Each layer in itself is a rather flimsy defense. Flight Crew Training Centre .8 Swiss Cheese In the example above it might appear that this was one very unlucky scenario. it snaps.

flying to close to a thunderstorm Violations – intentional non-compliance – i. Threats and errors are unavoidable. The safety record in the airline industry is held in high regard. There are four broad classifications of flight-crew errors:      Procedural – appropriate procedure followed but incorrect execution – i. and it is up to us to break the chain. but they are well managed within a system that has countless checks and balances. but as long as the holes do not line up.10 Threat and Error Threat is defined as an influence.External influences Errors .Page: 10 CRM Manual Date: January 2008 We cannot have a foolproof layer of defense. the start of an accident chain. 3. Most errors committed by the flight-crew are inconsequential.) Threats . wrong altitude selection on MCP Communication – missing information or misinterpretation Decision – elective decision by crew that unnecessarily increases risk – i. performing a checklist from memory. Some examples of common threats are:      Adverse weather Terrain Airport conditions Aircraft malfunctions Automation events.e. Errors made by the crew during normal and nonnormal operations may require intervention to prevent an unsafe situation arising. safe operations are the norm.e. Management. 3.e. (Errors made by other people ATC. Line Operational Safety Audits (LOSA) observations have shown that over 70% errors are inconsequential. the accident chain is broken. Engineering. Regulators etc are threats to the crew. The latest statistics indicate that one accident occurs per million aircraft departures. at any level. in fact almost half of all errors go totally undetected by the crew. external to the flight-deck that requires action to ensure safe operation. The last layer of defense is the flight-crew.9 Threat and Error Management Aviation is a hazardous industry but it is not a dangerous one. because despite the risks.Internal influences Safe operation depends on management of those threats and errors that cannot be completely eliminated. Flight Crew Training Centre . A small percentage (8%) results in additional errors.

However in all cases. the crew failed to see the threats and usually compounded them by making additional errors. The purpose of the NTSB review was to enable flight-crews to recognize that when multiple warning flags exist. nine common factors existed. However. research has shown that flight-crew error led directly to an undesired aircraft state.11 Warning Flags Aircraft accidents tend to have many similarities. presence of several of these warning flags should alert us to the possibility of danger. 3. 3. great care should be taken to avoid compounding the problem by making additional errors. The NTSB identified in 1994 that of 37 commercial aviation accidents reviewed. Trap. Mitigate How we deal with these threats and errors depends on the phase of flight:    Avoid Identify potential threats/errors in advance and avoid them Trap Identify current threats/errors that are developing.Page: 11 CRM Manual Date: January 2008 Over 20% of the time though. These have been termed warning flags.12 Avoid. The flags can be loosely divided into threats and errors: Threats Captain flying Experience gradient First duty day Time since awake Operational stress Errors Procedural error Poor tactical decision Failure monitor/challenge Improper checklist use Those accidents described below and covered during Jade Cargo International CRM courses have many of these warning flags clearly identifiable. such as an unstabilized approach. We have already determined that we cannot expect to work in a risk-free industry. and correct them Mitigate Identify errors that have occurred and limit the damage Flight Crew Training Centre .

“Look after number 1” regardless of the effect on the operation Low IDV – Focus is on the gain for the collectivist whole regardless of personal inconvenience or benefit. Uncertainty Avoidance. This chapter identifies the key concepts that differentiate national cultures and also examines the influence that may occur as a result of particular sub-cultures. The last two do not typically apply to pilot groups. The word “collectivism” in this sense has no political meaning: it refers to the group. On the individualist side we find societies in which the ties between individuals are loose: everyone is expected to look after him/herself and his/her immediate family. versus its opposite. not to the state. The five dimensions are Individualism/Collectivism.2 National Culture Most discussion about culture tends to centre on the effects of national culture. 4. (which are predominantly male). Again. Jade Cargo International has identified that cultural issues represent a significant difference from a typical airline CRM program. On the collectivist side. the issue addressed by this dimension is an extremely fundamental one. Power Distance. professional and safety culture. often extended families (with uncles. He identified five dimensions where cultures differ. 4. Hofstede carried out the principle research in this area1. A compromise between the two extremes is what is desired for safe operation Flight Crew Training Centre . is the degree to which individuals are integrated into groups. having left their country of domicile for economic advantage.Page: 12 CRM Manual Date: January 2008 4 Culture 4. regarding all societies in the world. collectivism. aunts and grandparents) which continue protecting them in exchange for unquestioning loyalty. cohesive in-groups.1 Introduction Due to the diverse nature of the workforce.3 Individualism/Collectivism (IDV) Individualism on the one side. such as organizational.4 Effects on Crew Behaviors     High IDV – Personal gain and protection of oneself are the main priorities. we find societies in which people from birth onwards are integrated into strong. Expatriates are typically of a more individualist nature. The remaining three dimensions are discussed below. Long-term/ Short-term orientation and Masculinity/Femininity. 4.

it ultimately refers to man's search for Truth. Effects on crew behaviors:  High UA Rigid adherence to procedures and SOPs. unknown. they try to have as few rules as possible. and motivated by inner nervous energy.   4.Page: 13 CRM Manual Date: January 2008 4. but defined from below. are more tolerant of opinions different from what they are used to. “I know better than the people who wrote the books” style of operation. of course. People in uncertainty avoiding countries are also more emotional. Effects on crew behaviors:   High PDI – can lead to an autocratic leadership style by the Captain – a steep cockpit gradient Medium PDI – a consultative style where input is sought but the final decision is made by the Captain Flight Crew Training Centre .6 Power Distance (PDI) Power-Distance is the extent to which the less powerful members of organizations and institutions (like the family) accept and expect that power is distributed unequally. as much as by the leaders endorse a society’s level of inequality.5 Uncertainty Avoidance (UA) Uncertainty avoidance deals with a society's tolerance for uncertainty and ambiguity. Power and inequality. It suggests that the followers. and on the philosophical and religious level by a belief in absolute Truth. safety and security measures. and not expected by their environment to express emotions. “there can only be one Truth and we have it”. This represents inequality (more versus less). Uncertainty avoidance is the extent to which members of a culture feel threatened by the uncertain or unknown. and on the philosophical and religious level they are relativist and allow many currents to flow side by side. Low UA Disregard for SOPs and procedures. Power distance can be related to cockpit gradient. are extremely fundamental facts of any society and anybody with some international experience will be aware that all societies are unequal. “A rule for every situation” approach to flying and a marked reluctance to deviate from SOPs even if the situation demands it. uncertainty accepting cultures. Uncertainty avoiding cultures try to minimize the possibility of such situations by strict laws and rules. People within these cultures are more phlegmatic and contemplative. and different from usual. It indicates to what extent a culture programs its members to feel either uncomfortable or comfortable in unstructured situations. surprising. Medium UA is optimum for the flight deck. but some are more unequal than others. not from above. Unstructured situations are novel. The opposite type.

such as pilots. Flight Crew Training Centre . but the pilots’ perceptions of the Company’s intent.1 Introduction Automation is defined as the replacement of a human function.Page: 14 CRM Manual Date: January 2008  Low PDI – decisions arrived at by consensus with all crew having equal Input 4. Improvements in technology (automation) have resulted in only the two pilots remaining as required crew. Furthermore. (Norbert Wiener) 5.7 Organizational and Professional Culture Although national culture tends to dominate in most circumstances. It is not the policies themselves that are a potential problem. promotion of a safety culture might be encouraged for the pilot group to resist a perceived weakness in any national characteristic. against a conflicting trend. though the Air Safety Report and Confidential Human Factors Reporting schemes. Although there are numerous examples of the introduction of automated systems on the flight deck. 5. and also provide some guidance for the management of automation issues. either physical or cognitive.2 Flight Deck Automation Early jet transport aircraft had a crew of five or six on the flight deck. In particular. navigators and flight engineers. An “On time departure” policy or a “Minimum Fuel” policy might lead to unnecessary pressure to compromise. The aircraft manages and self-monitors many of the functions that were previously in the domain of the other crewmembers. it is those automatic functions relating to flight path control and navigation with which we are primarily concerned. including radio operators. 5 Automation The problem with computers is that they do what they are actually told to do. In Jade Cargo International we have a structure that emphasizes “Safe and efficient”. not what we thought we told them to do. by a machine function. this may or may not conflict with a Company’s management style. or an organizational culture can prevail. there can be anomalies where a professional group. This chapter investigates the benefits and the traps associated with automation. The reason that this has been acceptable is that the residual workload has remained at a manageable level. This is endorsed by an open-reporting policy for safety and human factors issues.

it is the understanding of the automation that causes concern. often at the wrong time Difficulties with Situation Awareness New knowledge and skills required New error associated with communication The table above illustrates how the intended benefits of automation will not be achieved without additional effort.3 What to Automate Prior to deciding on what to automate. engineers automate what they are able to automate and the rest is left for the human operator to manage. roles of humans change Creates more cognitive work. There are (system) performance issues associated with the introduction of automation. same system (substitution) Reduction in workload Focuses user attention Less knowledge required Reduces error Reality Transforms practice.Page: 15 CRM Manual Date: January 2008 Why automate? “Automation brings increased safety. In practice this does not always happen. Flight Crew Training Centre . The latter will not be discussed here. accuracy and reduced costs. “Dekker and Woods” highlighted the apparent benefits of automation against the real effect: Table 1: Benefit of Automation: Intended Benefit Better Results.” This may be the intention but the statement doesn’t provide the whole story. not to mention the human (social) effects. The problem with automation is therefore how man and machine interact – the interface. it would be a good idea to determine the comparative advantages of humans and machines. it is that humans are still required for the part of the task that cannot be automated. 5. In particular. The issue of automation is not whether a machine is capable of doing the job.

error correction Good at error correction Specialized. P. accurate.4 Fitts’ List In the 1950s. J & George. inaccurate. difficult to re.Good inductive. Poor at pattern assessment Wide energy ranges. slow communication Better for principles and strategies. fast.” (Good. Rather.Page: 16 CRM Manual Date: January 2008 “Engineering is not the process of building a perfect system with infinite resources. narrow range. Spine. slow. some multi-function Sensing Perceiving Good at coping with Poor at coping with variation in variation in written & written & spoken material. User-derived impact analysis as a tool for usability engineering) 5. The “Fitts” list’ is still valid today: Table 2: Fitts’ list3 Skill Speed Power Output Consistency Information Capacity Memory Machine Much superior Superior in level and consistency Ideal for repetitive activity Multi-channel. The principle task allocated to humans on the flight deck involves monitoring for which we are not ideally Flight Crew Training Centre . engineering is the process of economically building a working system that fulfils a need. Poor spoken material. T. easy to re program. detecting messages in noise. Most notable of the differences from a flight-deck perspective is that humans are poor monitors and good at accepting revised plans. 1986. access restricted and formal Human Comparatively slow Comparatively weak Unreliable. Poor at at detecting messages in noise. access versatile and innovative Reasoning Good deductive. fast communication Ideal for literal reproduction. subject to learning and fatigue Single-channel. Whiteside. Fitts identified those skills where machines exceeded and those where the human is better. Poor program. Good quantitative assessment. M.

although “fly-by-wire” will still be assisting.    The potential problem that we face is that if we operate for too long in the fully automated regime. Although in some systems. an area of weakness in interface design. but the pilot is relieved of the task of manual flight. such as nuclear power-plant control rooms. In its current mode the aircraft will intercept the inbound course. according to any change in tactical goal. vigilance and complacency may become issues. In the aviation scenario. resulting in further reduced workload. Note that the pilot is still actively involved in the task and through FCU/MCP manipulation retains situational awareness of the flights progress. with different cognitive skills required. 5. in practical aviation terms we have identified four levels of automation. This refers to the level of monitoring and decision-making required by the operator. Monitoring or supervising is the principle role left to the pilot. Autopilot with basic/selected modes: The cognitive demand is as above. The automation on the other hand may need to be re-programmed for last minute changes. Autopilot with fully managed modes (LNAV/VNAV): The pilot no longer has to calculate closing rate information or fly the aircraft. Overall result is reduced workload. Consider the case where an aircraft is on an intercept heading for an instrument approach:  Manual flight without flight director: requires the pilot to manually fly the aero plane and monitor the closing rate of the inbound track and adjust accordingly. There is a reduced cognitive load. Pilots will dynamically move between levels. The principle pilot skill on modern generation automated aircraft knows which mode of automation is most appropriate to the task. Manual flight with flight director: the pilot now has a reduced cognitive load as he no longer has to interpret closing information. including when to turn it off! Flight Crew Training Centre . this refers to how far removed the pilot is from the actual job of flying the aircraft.Page: 17 CRM Manual Date: January 2008 suited. so the overall workload is drastically reduced. It also becomes more difficult to revert to more basic modes with reduced automation. – This is a high workload situation.5 The Automation Pyramid Research literature on automation talks about levels of “supervisory control”. it is possible to differentiate seven distinct levels. These four levels of automation are available to us to use as appropriate for the situation. but the system must be programmed to give the correct guidance.

Unfortunately. It has already been noted that the introduction of automated features changes the role of the pilot. The key issue is with the design of the interface: how the pilots and the automation communicate. If we do not fully understand the system we are not able to anticipate the system response or evaluate its performance. the pilots still have to intervene at critical moments when the automation cannot cope. Cali. The FAA identified this weakness and commissioned a study that reported in 1996. Studies have revealed that “mode” errors are among the most common on advanced aircraft. Flight Crew Training Centre . The report identified links between automation and situational awareness. having been unable to completely replace the pilots with automation. 5. it is important to address the issues identified by accident reviews. as routine automation takes away the opportunity to rehearse basic flying skills the skill and practice required by the pilots to manage these events is lacking. The highest workload situations tend to be left un-automated. In particular. communications and monitoring. will disengage or will revert to another mode. Habsheim etc). Using automation requires us to:    Understand each mode before selection Anticipate how the aircraft will react to the mode change Evaluate whether the desired effect has been achieved Numerous accidents have resulted as a result of pilot inputs that were not appropriate for the correct completion of the desired task (Nagoya.Page: 18 CRM Manual Date: January 2008 5.6 The Irony of Automation The irony of automation is that.8 Interfaces The blame for this lack of understanding is not necessarily with the pilot. The major problem that has been identified with automation is due to a lack of understanding.7 The Automation Issue Now that the benefits and drawbacks of automation have been identified. the FAA recommended that operators’ manuals should provide “clear and concise guidance” on conditions when the auto-pilot or auto-throttle will or will not engage. For this new knowledge and skills are required. 5.

The Jade Cargo International procedure’s of calling FMA changes is designed to counter this threat. feedback results in a reduction of situational awareness. These cues reinforce situational awareness and help keep the flight crew fully aware of changes occurring to the airplane’s status and flight path during all phases of automated and manual flight. Consequently. A lack of. or subtle. When was the last time you had to refer to a user manual for a chair or a tea-pot? …or a video cassette recorder…? Flight Crew Training Centre . These systems support instrument displays with visual and tactile motion cues to minimize potential confusion about what functions are automated.Logical layout of controls and displays Use of natural command language (Windows v Dos) Minimal user memory load (prompt keys) Consistency Feedback Clear. but not replace.11 Ergonomic Design Principles The following design principles have been identified as necessary for producing a usable interface:        Intuitive .Page: 19 CRM Manual Date: January 2008 5. Appropriate feedback makes the task of monitoring system failures or anomalies more effective. 5. Boeing and Airbus flight decks are designed to provide automation to assist. easy-to-use systems. the flight-crew member responsible for safe operation of the airplane. 5.9 Feedback “Norman” contests that the real issue with automation is due to poor or inappropriate feedback. Feedback is also required for monitoring normal system status change. The failing of the man-machine system is because the pilot is no longer “in the loop”.10 From an Aircraft Manufacturer Appropriate degree of automation. Flight-crew errors typically occur when the crew does not perceive a problem and fails to correct the error in time to prevent the situation from deteriorating. Understandable error messages Error prevention These principles apply to computerized systems as much as day-to day items. Boeing and Airbus flight decks incorporate intuitive.

the Captain is the designated “leader”. Humans are capable of devising strategies.1 Introduction There are various competing theories about what makes a leader and the definition of leadership. 6.12 Conclusion Automation is seen as the antidote to pilot error. and an understanding of the goals and desires of the group. Aircraft accident and incident investigations have demonstrated that personality differences can influence the behavior and performance of crewmembers. Recognition of a poor design is part of the way towards eliminating the threat it poses. Flight Crew Training Centre . An optimal situation exists when leadership and authority are combined. 5.2 Leadership A leader is a person whose ideas and actions influence the thought and the behavior of others. In the flight-deck environment. and authority. There is a fundamental difference between leadership. yet numerous accident and incident reports identify where the leader has failed in his role and remarkably has not exercised leadership. We must guard against the threats posed by automation. An individual's position as captain does not automatically assume that he or she is an effective leader. Through the use of example and persuasion.Page: 20 CRM Manual Date: January 2008 The advantage of retaining humans in the system is that they are adaptable and flexible. Appropriate feedback is vital to achieve and sustain the high levels of situational awareness required for safe operations. 6 Leadership and Team Dynamics 6. This chapter will identify some of the attributes necessary for effective leadership and identify how styles of leadership vary. either as an organization or as individuals to reduce the threat posed by a design that is less than perfect. Personality or attitude clashes within a crew complicate the task of a leader and can have an influence on both safety and efficiency. which is assigned. Leadership is needed to effectively understand and cope with a variety of situations. In fact it has generated the potential for a different type of human error. by knowledge of the appropriate levels of automation and understanding of the automated systems. which is acquired. the leader becomes a means of change and influence.

This implies a certain amount of discretion in choice of action. Action. An effective leader must have both technical and personal skills. As leader the Captain has both responsibility and accountability. The leader must balance the demands of the task. In addition. and be able to maintain team morale. Some of this is relevant in the sphere of commercial aviation.Page: 21 CRM Manual Date: January 2008 The Captain’s authority as leader is derived from the China Civil Aviation Regulations. 6. however the leader also has other areas of responsibility. Task Team Individuals Figure 1: Action Centred Leadership Flight Crew Training Centre . to decide on a course of action.4 Action-Centred Leadership Pilots tend to be naturally task-focused individuals. 6. initiative and integrity. the team and the individual. Personal qualities required are those of courage. with use of the Assess. from a practical view point the Captain has a right. The importance of each sphere of responsibility will change dynamically according to the situation. and Manage Decision-Making Model. and a duty. any limitations of this knowledge must be identified. The leader must have a thorough technical knowledge of the aircraft and appropriate supporting systems. along with recognition of the appropriate source of assistance and the correct answer when provided. In fact. will power. Jade Cargo International SOPs and technical training support this function of leadership. An ability to communicate and self-motivation are also vital.3 Leadership Theory Early research into leadership theory stems from the military.

many of the considerations for the team also apply for managing an individual’s needs. Maintain situation awareness Monitor and evaluate the task’s progress 6.Page: 22 CRM Manual Date: January 2008 6.7 Individual Development and Satisfaction In the two-pilot flight deck. consider the following:      Planning Communication of intent Avoid over-involvement as it reduces the capacity to think ahead. manage and direct the flow of information. suggestions Clarifying communication Providing feedback Regulating participation Flight Crew Training Centre . ideas and suggestions within the crewmembers and outside sources       Communicating flight information Asking for opinions. With a wide variety of background. experience and culture in Jade Cargo International the following techniques may also assist in promoting the individual’s needs:    Sensitivity to cultural needs Maintain an open environment by active listening Admission of errors and encourage Standard calls to identify deviations 6.1 Regulating Information Flow The leader must regulate.6 Team Building and Maintenance Team work is vital for an effective solution to a task.5 Task To achieve the task.8 The Role of Leader The CRM Manual produced by Transport Canada identified the following four tasks that encompass the role of the leader: 6.8. To enhance the sense of unity:     Use expertise within the team Briefing Co-ordination of effort Provide feedback 6. suggestions Giving opinions.

In between. coordination and direction for group performance     Directing and coordinating crew activities Monitoring and assessing crew performance Providing planning and orientation Setting priorities 6. there are differing degrees of participation such as democratic and participative.3 Motivating Crew Members The leader must maintain a positive climate to encourage good crew member relations and to invite full participation in crew activities      Creating proper climate Maintain an "open" cockpit atmosphere Resolving/preventing angry conflict Maintain positive relations Providing non-punitive critique and feedback The leader is ultimately responsible for decisions      Assuming responsibility for decision making Gathering and evaluating information Formulating decisions Implementing decisions Providing feedback on action 6.Page: 23 CRM Manual Date: January 2008 6. how is this delivered in practice? Leadership style refers to the degree of involvement between the leader and the team during decision-making.2 Directing and Coordinating Crew Activities The leader must function as crew manager to provide orientation. Flight Crew Training Centre . It can range from the extreme of autocratic or dictatorial to “Laissez-faire”.8.4 Leadership Styles Having determined what is required of a leader.8.8.

but not if things are going wrong.   Autocrat [A1]: solves the problem or makes the decision alone. For most effective leadership. rather than generating or evaluating alternative solutions. Does not necessarily tell subordinates what the problem is while getting the information from them. a different style is adopted according to the situation. The definition used here is “laissez-faire”. Consensus Seeker [G2]: shares the problem with subordinates as a group. “VROOM” has isolated five categories on the scale above. Consultative Autocrat 3 [C2]: shares the problem with subordinates as a group. while monitoring to assure necessary performance. This differs from a “relaxed” attitude. It may be acceptable to be “laissez-faire” when all goes well. in this case the leader does not care whether the team performs well or not. Then makes the decision that may or may not reflect your subordinates' influence. collectively obtaining their ideas and suggestions. generates and evaluates alternatives and attempts to Flight Crew Training Centre    . Then makes the decision that may or may not reflect the subordinates’ influence. regardless of performance – which is unacceptable on the flight deck. These definitions below provide more detail to assist with understanding the concept. and then decides on the solution to the problem alone. Consultative Autocrat 2 [C1]: shares the problem with relevant subordinates individually. Together.Page: 24 CRM Manual Date: January 2008 Laissez Faire Democratic/Participative Autocratic Figure 2: Authority Dynamic Range While “laissez-faire” (loosely translated as anything goes) might appear to be an appropriate attitude. The role played by subordinates in making the decision is clearly one of providing the necessary information. using information available at that time. Note that an individual need not always be associated with only one style. getting their ideas and suggestions without bringing them together as a group. Consultative Autocrat 1 [A2]: obtains the necessary information from subordinates.

Hughes. Flight Crew Training Centre . RE. since there are a number of nationalities. which may differ between individuals and national cultures. along with good communication skills. supportive followers are as important as a leader. encourages an open atmosphere to monitor and challenge. cited by Kern. Jade Cargo International encourages a flat cockpit authority gradient.  Trying not to influence the group to adopt "own" solution and willing to adopt and implement any solution that has the support of the entire group.9 Cockpit Authority Gradient In addition to the style adopted by the Captain. Followers are a vital part of a team. levels of experience and different cultural backgrounds among the workforce in the company. “Kelly’s” (Kelly. R. active/uncritical and active/critical. 1988. Redefining Airmanship) model of followership examines two dimensions. G2. A fifth group “Company men” is chameleons adopting any of the four other styles as appropriate. Ginnett. Of these classifications it is worth noting that the last. A two-dimensional model of follower behavior in Leadership: Enhancing the Lessons of Experience. while respecting the Captain’s legal authority. The four combinations available are therefore passive/uncritical. T. The role is much like that of a chairman.10 Followership Followership is often perceived as a short-term necessity on the way to a leadership position. R & Curphy. Nevertheless the duties and responsibilities of the pilot-in-command should in no way be affected by this need. that of dependent/independent uncritical/critical thinking and active/passive involvement in the team’s performance. The optimum gradient. For successful team performance. 6. the interaction between the flightdeck members will define the authority gradient between the two. A steep gradient results in ineffective monitoring from the co-pilot. 6. avoids the Captains’ obligation and duty to make a decision and to accept responsibility.Page: 25 CRM Manual Date: January 2008 reach agreement (consensus) on a solution. from the team perspective nothing could be further from the truth. and a flat one reduces the Captains’ authority by constant (unnecessary) challenge. 1997. G (Eds). An effective follower requires qualities of flexibility and adaptability. predictability and an appropriate level of assertiveness. and followership is a skill in its own right. passive/critical. While this might be an individual’s view.

They are also the foundation for teambuilding. Making a good first impression is vital.Page: 26 CRM Manual Date: January 2008 Effective followers are essential to safe flight. An airline crew needs to be working together and communicating well from before the take-off roll. unless identified and brought “back onside”. They inhibit crew decision-making and can encourage a feeling of invincibility to the pilot-in-command. because they actively support without thinking. Yes people can add an element of danger to the operation. Flight Crew Training Centre . not afraid to speak up when necessary and challenge a flawed decision. Their motivation is political rather than task/team oriented. The crew briefing is probably the only opportunity to foster a vital link between the flight deck and the cabin. they are typified by mediocre performance and shift quadrants. 6.11 Team Dynamics Unlike military crews. airlines form new teams for practically every duty. A poor first impression could take as long as seven hours of continual contact to undo. Team building is therefore a skill that needs to be emphasized if a “scratch” crew is to perform well. and actively supportive without being “yes men”. Survivors are the Company men. not to foster an effective team but to avoid making waves. completing tasks in silence without adding to the team’s performance. The only way to ensure this is. Sheep are akin to human automatons. Good communication skills have already been identified as critical for both leaders and followers. Using the first minutes of meeting effectively is obviously very important. to give the best possible impression during the crew brief and ensure that both pilots come across as open to communication from the crew. Alienated followers are those that have identified a problem with the operation. They have the potential to destroy a team’s effectiveness. A good first impression is vital for successful team bonding and should be accomplished in the first few minutes of team formation. but through disillusionment and disenchantment are not prepared to speak up.

There are many barriers to communication within a cockpit. However.Page: 27 CRM Manual Date: January 2008 7 Communication 7. So. 7. rank could impinge on communication as well.1 Introduction One of the key skills required for operating a multi-crew aircraft is the ability to communicate. 7.3 Communication Barriers The flight deck of an airliner is not an ideal place to have a conversation. This chapter describes the principles of communication. insulting. the words used tend to be very important. along with methods of eliminating them. This can be verbal or non-verbal information. in communication within a crew. The actual words used accounting for only about 10% The impact of body language is greatly reduced in a flight deck. and very rarely are raised voices heard.e. This is the most relevant definition to the task of flying an aircraft. The actual words used accounting for about 10%. While modern flight decks are well insulated. verbal communication is one of the oldest forms of human interaction.2 Principles of Communication Human communication is the act of sharing information. noise is still a factor. Body Language and tone of voice makes up for the majority of human communication. Communication on the flight deck can be affected primarily by:    Tone of voice Focusing on own/others’ needs The use of emotional language or “put-downs” i. the advantages of various communication styles and the requirement for conflict resolution. This chapter is aimed at producing effective crew communication in the context of multi crew operations. Barriers to communication are also identified. In the case of Jade Cargo International. culture plays a large part. degrading language. Between a Captain and a First Officer. It serves a complex and vital role in establishing and maintaining relationships Flight Crew Training Centre . as much as 90%. Communication breaks down barriers and promotes the exchange of important information. as does the fact that many of our pilots do not use English as their native language.

7.4 Communication Styles To assist in analyzing effective communications. a lively discussion in low workload phases usually goes a long way toward “setting the tone”. the focus. supportive and submissive.Page: 28 CRM Manual Date: January 2008 between people. Flight Crew Training Centre .4. 7. Being Assertive:    Heightens self esteem Makes other people take notice Establishes authority Assertive behavior is a desirable form of communication. This is especially in the flight deck from a person in a position of authority.1 Assertive Behavior [a1] An assertive style enables one to speak in such a way that one does not abuse or dominate others. From these two aspects the following model can be constructed: Table 1: Communication Styles “No put-downs” (1) Focus on own needs A Focus on needs of others S Assertive A1 Supportive S1 “Put-downs” (2) Aggressive A2 Submissive S2 Four communication styles can be determined from this model. whether unnecessary emotional language or “put-downs” are used. assertive. aggressive. and the manner. two aspects of the message content will be considered. It is stating our own needs and feeling without putting others down. By adhering to these “standard calls” the danger of miscommunication is greatly reduced. While a silent flight deck is desirable in some stages of flight. The principle means of communication is by the use of Standard Operating Procedures (SOPs). Establishing a cordial and efficient working relationship can be made easier by the use of some of the techniques covered in this chapter. The SOPs contain standard phrases and occasions when exchanging information or verifying facts is required. whether on the needs of others or your own.

Therefore. Aggressive behavior will have a negative impact on a team. and will likely isolate the aggressor. 7. A2 behavior rarely occurs without precursors. Referring to the matrix. When aggressive feelings burst forth we tend to regret it afterwards because serious negative consequences usually occur as a result of aggression. It is important that “put downs” or words or tone of voice that may be interpreted as such.downs. They put themselves down. This is a “no-go” area for us at work. it is clear that aggression comes about when an individual is focused on his own needs and uses put. Being focused on one’s own needs is very human.4. such as during training or non-normal situations. A person being supportive will:    Show concern Not diminish their own or others’ worth Be willing to help and listen In a typical crew the PNF should adopt a supportive role. The key to identifying aggression is the use of “put downs”.4. not recommended but part of life. However this may change depending on circumstances.3 Supportive Behavior [s1] A supportive style focuses on others needs in a way that does not downgrade themselves.Page: 29 CRM Manual Date: January 2008 7. 7. Flight Crew Training Centre . Defining a “put down” is not easy and it is incumbent on all parties (particularly in a multi-cultural environment such as Jade Cargo International) that great care is taken to avoid anything that can be construed to be one. In a non-critical situation. However.2 Aggressive Behavior [a2] This is when someone is being aggressive. are avoided at all times. the key here is the use of “put downs” or abusive language. It is unlikely to motivate the team.4. is it better to be submissive in order to defuse a situation? Sometimes it may be preferable to “let it go” in order to preserve harmony.4 Submissive Behavior [s2] The simplest definition of submissive behavior is the acceptance of “put downs”. A person using a submissive style of communication allows himself to be dominated. With a submissive style the individual focuses on others’ needs in a way that diminishes their own worth.

This brings the focus back to the task at hand and reduces conflict. be supportive.Page: 30 CRM Manual Date: January 2008 Sometimes a person will prefer not to say anything for fear of being laughed or shouted at. their needs will be overlooked. In fact submissive behavior often comes about as a result of aggressive behavior on the part of another person. Since the safety of the flight is of paramount importance and is a common need between all parties.5 Dealing with Aggression If aggression is met with aggressive behavior. The use of the communication styles model identifies boundaries between own/others needs and the use of “put-downs”. An assertive response might also be effective. it is likely communication that will break down completely. It may be necessary to vary the style of communication according to the situation. Some of the factors that affect the position of these lines are:      Race Culture Nationality Age Seniority / Rank It must be emphasized that the lines move all the time. Each individual and in fact every team. will find a style that works well for them. Assertive and supportive behavior styles are those that promote the most efficient communication. These boundaries are not necessarily static or evenly divided. If someone is submissive. provided that the intent is to stop the use of put-downs. Being aware of this and expecting it from yourself and others goes a long way toward fostering good communication. In other words. If the other person is submissive. but leads to good understanding when accomplished. Establishing the position of the lines can be difficult. Flight Crew Training Centre . Dealing with aggression is not easy. focusing on this usually helps in restoring harmony. and perhaps discount their views even in a crisis 7. The best response is to focus on the other person’s needs (where this does not compromise safety) and ignore the perceived put-downs. the assumption might be that they have nothing to contribute.

Unwillingness to work through issues. High respect for mutual support. objectives and values. and the damage is usually difficult to repair. actions and situations. If conflict does occur. Conflict is not a necessary component of human behavior. collaborate or compromise. Animosities can develop. Conflict resolution can be achieved on a win/win basis and this produces the best results. When sides are chosen.7 Problem Solving     Needs of both parties are legitimate and important. Resolving conflict requires an analysis of the root cause of the conflict. You must give to get. There is more than one way to do anything. depending on how those involved choose to approach it. and stretch their imagination. the results may be positive or negative.6 Conflict Resolution Any time two or more people are brought to work together. Conflict becomes unhealthy when it is avoided or approached on a win/ lose basis.8 Compromising     Important all parties achieve basic goals and maintain good relationship. but unfortunately does occur a great deal.favorable versus unfavorable. test their position and beliefs. Reference to the Action-Centred Leadership model1 can assist in probing sources of differences. trust and support will deteriorate. Conflict is healthy when it causes the parties to explore new ideas. 7. words. No one person or idea is perfect. Differences in perceiving motives. Differing expectations of outcomes . When conflict is dealt with constructively. the stage is set for potential conflict. It is possible to cooperate with conflict arising. Assertive and cooperative. productivity will diminish or stop. communications may breakdown. No one makes major concessions. people can be stimulated to greater creativity. which will lead to better results. The two key learning points in resolving a conflict are: 7. Conflict should not be taken as another word for not working together. Flight Crew Training Centre . Conflict is usually present because of:     Differences in needs.Page: 31 CRM Manual Date: January 2008 7. What is important when conflict does occur is that the issue is resolved and that safety is not compromised.

which provides a structured approach to problem solving and decision-making. This chapter introduces the Company decision-making model. rather that a model is used.1 Introduction Problem-solving and decision-making are activities we conduct instinctively every day. Using a structured approach is a form of SOP for decision making. Conflict Resolution. Advocacy. It is the end result that we are interested in. Flight Crew Training Centre . once in a while. Most of them are based on the original CRM loop of Inquiry. and reduces the risk of omissions and errors in the assessment phase of the problem. The importance of time management is also covered in this chapter. However. This raises the question as to whether we should consider good or bad decisions. Using a structured approach for problem solving and decision making leads to a better outcome. it is possible for diverse personality types from widely disparate cultures to work together harmoniously and ensure safe flight. 8 Problem Solving and Decision Making 8. GOOD OUTCOMES ARE GENERALLY ENSURED BY THE USE OF     Briefings Sharing the workload Planning for change Using aircraft equipment to your best advantage POOR OUTCOMES ARE CAUSED IN PART BY:      Attitudes Failures of judgment Deviation from SOPs Lack of briefings leading to misunderstandings and omissions Emotions overcoming good judgment Various structured models are in use in airlines around the world.Page: 32 CRM Manual Date: January 2008 Provided these concepts are borne in mind. 8.2 Structured Decision Making Research has identified numerous occasions where similar accidents nearly occurred. It is not which model that is used that is important. a situation arises that is beyond our scope or experience. or good or bad outcomes. either for routine or novel situations. Action and Critique. however it is the industry’s belief that a structured decision making process will reduce the risk of a poor outcome.

2. Flying skills and good management of the auto-flight systems is also applicable throughout the application of the RMM. as well as the appropriate CRM principals. further modification to the RMM was required. it was decided to call this the “Action Phase”.Page: 33 CRM Manual Date: January 2008 The Jade Cargo International. indicating when manufacturer’s company procedures should be applied. “The Situational Assessment Model focuses on factors that influence a flight crew’s assessment of a situation and the subsequent management of available resources”. 8. Risk Management Model (RMM) is for the two man crew cockpit. The RMM is based on the assumption that the crew is fully proficient with the following.2. Because this additional phase consists mainly of corrective actions. Flight Crew Training Centre . it is felt that the process to “Rectify / contain the problem” had very specific needs that could only be accommodated by allocating it to a phase of its own.2 Providing “Seamless Integration” To provide the required “seamless integration” as required by Advanced Qualification Program (AQP). according to the manufacturers non-normal checklist and or company procedures. 8.1 The Model “Footprint” The model is based on the “Battelle” “Situational Assessment Model” that had been developed for the FAA. During each of the phases specific guidance is provided.     Handling skills (manual and auto-flight) Technical knowledge (Type specific) Procedures (Manufacturer and Company) Basic Knowledge in Human Factors Principles It must be emphasized at the outset that the RMM and CRM is intended to provide an extra dimension to the Pilot’s management skills and not to make up for a lack of knowledge or skills in any of the above mentioned documents. This model was expanded to accommodate the following: Procedures to rectify / contain the problem Making a decision Implementing the decision However.

questions Problem Information [PI] – Analysis Information SI PI SE PE Sometimes it is more appropriate to spend time in gathering information before developing a solution. Any communication relating to this issue can also be considered as either information about the problem/solution or an enquiry. it is essential to accurately determine what the exact nature of the problem is. Jade Cargo International uses the catch phrase “stay below the line” to help crews focus on the issues related to the problem before taking action. its implications and how much time is available.Page: 34 CRM Manual Date: January 2008 8. the problem and the solution. Men in general and particularly pilots tend to go straight to a solution. The situation can be considered in two separate domains.3 A Problem-Solving Model Prior to deciding on a course of action. Jade Cargo International uses a problem-solving model to focus on the problem until these questions are answered. there are two typical responses. This does not always produce the best solution. a better understanding of the problem itself can be gained.Information seeking. Using these classifications we can use a model to identify the appropriate type of communication to best assist with resolving the situation. Whenever a problem is encountered at work. Flight Crew Training Centre . immediately come up with a solution or stay with the problem by further defining it. By staying below the line as much as possible. A key factor in making this decision depends on how much time is available. The line in question determines whether the discussion is centred on the problem (below the line) or on solutions to the problem (above the line). Enquiry Solution Problem Examples of each category are:     Solution Enquiry [SE] – Suggestion Solution Information [SI] – Instruction Problem Enquiry [PE] . to make sure we fully understand the implications. seeking more information about it.

Consider the likely responses to these two questions:   Where do you think we should divert to? Or Do you think we should divert to Munich? The first question is an open question [PE?].solving resource. using a traffic light system. The use of open questions can assist in staying below the line. taking too much time to collect information and make a decision. available and required. EFIS architecture. might compound Flight Crew Training Centre . Warnings and Time-Critical Warnings are coded red on EFIS displays. others may be less time dependent. A solution in the form of a question however. Once a time frame has been established. However there will be some occasions where it may be necessary to slow down or enter into a holding pattern. it is possible to prioritize accordingly. but will probably be accepted.  Time Critical situations require immediate action. critical.Page: 35 CRM Manual Date: January 2008 The key of “staying below the line” allows us to fully assess the problem within the available time. whereas the second is almost a suggestion [SE]. The effective use of time is very important in problem solving. all conversation tends to stop and the decision is implemented. time is available to consider the problem and when is appropriate to take action. Time Available: Cautions require a timely response.4 Time Management Some situations require an immediate response. when there is little available. this limits the opportunity for assessment. It is for this very reason that moving above the line should be done with caution. Caution level alerts are amber on EFIS. Time spent “below the line” is kept to a minimum. losing vital feedback. may at best get a query in response. They may be associated with immediate action drills (such as GPWS). Open questions allow more options.   The key to these different types of time is that EICAS/ECAM will assist with our assessment of time. On the other hand. In the latter case. Moving above the line is significant because it involves a suggestion or an instruction. Time can be considered as. recall actions (Engine Fire) or a checklist (Fire Wheel Well). In many cases it assists with our assessment of time. A fast decision may not always be the correct one. immediate action is required. 8. is a valuable problem. Assessment of how much time we have is essential in problemsolving. both in Boeing (EICAS) or Airbus (ECAM). Time Required: Other levels of alert may or may not necessarily be identified with color coding on EFIS. In all cases.

Page: 36 CRM Manual Date: January 2008 difficulties. This means that the F/O is best assigned the task of flying. NAVIGATE. Good teamwork needs good communication. COMMUNICATE CONTINUOUSLY [Use Autopilot if available] ASSESSMENT PHASE [Seek information. 8. Open Participation)  Brainstorm options and check for poor judgment  Summaries  DECIDE[selling if required IMPLEMENTING THE DECISION  Satisfy TASK. seek information. An early calculation of the time situation will assist with decisionmaking. test understanding. test understanding. Achieving the best solution demands good teamwork. prioritize. delegation] Remember that in complex situations. Flight Crew Training Centre . test understanding propose. the Captain must manage. GROUP AND INDIVUDUAL needs  MONITOR PROGRESS – continually check for poor judgment (PJ) [Participation. QRH If needed: “stop the checklist” MANAGEMENT PHASE [summarize. prioritize. keep partner in the loop] PROCEDURE TO RECTIFY / RECALL ITEMS / USE EICAS. summarize] CHECK CB’s AND SWITCHES ● IDENTIFY DIAGNOSE: What is wrong? • VERIFY How to RECTIFY • Identify procedure ACTION PHASE [Monitor.5 The Jade Cargo International Decision-Making Model RISK MANAGEMENT MODEL AVIATE. propose. build] EVENT STATUS Making the Decision Consider: TASK NEEDS Aircraft performance EROPS AWOPS ATC DDM/MEL GROUP NEEDS crew company passengers INDIVIDUAL NEEDS control stress individual crew members passenger  Options(Itemize best option.

For example in the first stages of a diversion. When the process is complete. 8. all the circles are the same size. including the navigation away from terrain. Action centered leadership is based on the principle that during a normal flight. An important point here is that you do not rush. It is only when you have to make decisions in somewhat abnormal situations that the weighting of the circles change. Once this is under control. a good commander will then address the passengers and crew and explain to them the steps taken. obstacles and weather. we must come back to summarizing our actions and again reflect and analyze our actions. if there were any elements of confusion during the initial assess phase. individual needs (a cup of coffee or a visit to the restroom perhaps) can be attended to. Once the problem is clearly defined and summarized should we then move above the line. the first priority is to maintain control of the aircraft. Once the Group is informed and placated. With the aircraft descending and flying in the desired direction. Use Action-Centered leadership to meet the needs of the task. 8. “Did the action solve the problem?” “Are you sure?” These are good questions to ask of oneself. Individual type procedures will determine what other action may be required. it is time to manage.7 Action During this phase the emphasis is placed on procedural/technical knowledge combined with good communication and monitoring techniques. Both the assessment and time factor may be provided by EICAS/ ECAM indications. It is a circular or iterative process. However.8 Manage Once the action has been completed. the team and the individual. the task need is paramount. Undue haste has led to more accidents than most people realize. Information may come from SOPs or other sources such as QRH or other manuals and will need to be clearly defined.Page: 37 CRM Manual Date: January 2008 8.6 Assess The assessment phase is characterized by problem-solving and time assessment. The specific action and or checklist required may be dictated by the type of situation. Flight Crew Training Centre . it diminishes in importance and the group need comes to the fore.

but functionally can be quite accurate. Flight Crew Training Centre . output functions and an internal processing function.3 A Model of the Cognitive Brain As in most processing flows. Some characteristics of mental models are:     They are incomplete and constantly evolving They are usually not completely accurate. individuals create internal representations of how systems work. This chapter looks in particular at some of the limitations of the human brain and the typical errors that can occur as a result. The importance of the model is that it is effective in assisting understanding. we will consider the brain in terms of input functions. A model may not be a very good literal representation of a system. they typically contain errors and contradictions They provide simplified explanations of complex phenomena They can be represented by sets of condition-action rules (If… then…) 9.2 Models Psychologists use models to produce a simple explanation of how something complex works. 9.1 Introduction Cognition is all about how humans process information. these are known as “mental models”. An awareness of these limitations and errors can reduce their impact on flight operations.Page: 38 CRM Manual Date: January 2008 9 Cognition 9. do something with that information and then act on it. Mental models are also a key component of situation awareness. In the same way. INPUT PROCESSING OUTPUT Figure 1: Basic Cognition Flow Very simply. we receive information. Mental models are vital to users for controlling systems and problem-solving.

This is quite normal.4 Input functions 9. but only a limited signal can be conveyed. sound. Routine (status) information is therefore conveyed by visual cues. 9. Attention is believed to be a single-channel function.4. Flight-deck design typically makes use only of the first three of these – sight. even though they do not have the loudest voice. if we miss-perceive an event. sound and touch. as firstly you would detect this new signal and secondly try to monitor it as well as the initial conversation. smell and taste. Those who believe that they can monitor two channels simultaneously. If someone nearby were to mention a key topic of interest to you (such as your name). Perception is incredibly powerful. However the brain does have a mechanism for making sure that we do attend to matters that affect us.2 Attention Our senses are constantly receiving and discarding signals. it is very difficult to subsequently identify it correctly and take the correct action to Flight Crew Training Centre . it would become increasingly difficult to maintain the original conversation. but it is not being ignored completely. Sound on the other hand is omnidirectional. are actually switching from one to the other. so much that. The “cocktail party” syndrome provides a useful example of this. touch.Page: 39 CRM Manual Date: January 2008 9. 9. During a busy.1 Senses We have five senses through which we receive information. The brain will filter the unwanted background noise. This refers to a “pre-processing” stage where the brain interprets what it thinks it has seen before dealing with it. 9. as many of the signals are neither intended for us nor relevant to us.4. at some point they will lose part of one or other signal.4. noisy social function it is quite possible to sustain a conversation with someone. warnings or “attention-getters” use audible alarms. We are unable to effectively monitor our principle task. sight. The advantage of sight is that quite complex information can be transferred to the user as long as they are looking at the signal. Attention is directed by the processing function and can be thought of as a filter to the overload of sensations all around us.3 Divided Attention Problems occur when we need to attend to more than one matter at a time. It is only possible to concentrate on one signal at a time. not all of them get through to the processing stage.5 Perception Perception can also be thought of as another filter by the processing function.

typically with the response “…was that for us?” but by the time the question is asked. 9. The processing function is considered to have two types of memory. and retained by conscious attention. In this case the “echoic” memory (of the auditory system) can retain the data for as long as 10 seconds. expect 150 by xxx.6. However it becomes more manageable even with additional information in the form – “Heading 285.1 Memory Memory is the storage area of the brain. Iconic memory (for visual stimuli) is almost literally gone in a flash. We can increase the effectiveness of our short-term memory by “chunking” information. which really belongs with the input functions. you have as little as 0.Page: 40 CRM Manual Date: January 2008 deal with the problem. Perception is considered to be the first stage of Situational Awareness. speed 310.3 Short-Term Memory Short-term or “Working” memory is extremely limited and slow in operation. for instance if you are looking in the general direction of the EICAS/ECAM and a message pops up and disappears. Flight Crew Training Centre . New information received on top of this will replace the current contents of working memory. Another type of memory is sensory memory. It has a capacity of approximately seven bits of information. The mind can have difficulty perceiving something it has never seen before or that appears to be impossible.6 Processing Functions 9.72”. the original message has been replayed by the mind.6. 9. and contact 119. unless it is consciously being dealt with. Psychology text-books (and the internet) have numerous examples of such illusions. An example might be an R/T call that interrupts a conversation.2 Sensory Memory Sensory memory refers to how long the senses maintain received data before it is consciously dealt with or lost. The string “28531018015011972” is clearly longer than seven digits. short-term and long-term.5 second to replay the stimulus before it is lost.6. 9. Sensory memory data is lost by decay. descend 180.

but with inability to retrieve or access the information. Retrieval of information is fast and effortless and parallel processing is available. One technique to assist with retrieval is the use of mnemonics. patterns or mini theories. Data is stored in one of two methods by the long-term memory. long after the event. using “motor actions” without recourse to the conscious workspace. but becomes irretrievable due to interference. Data in the long-term memory can be in the form of single bits of data or in the form of learned routines. It is believed to be unlimited in capacity and lasts forever. However the problem is not with forgetting. Usually the event and what you were doing at the time are inextricably linked as one memory. 9. such as ATM (Avoid. Short-term memory data is lost by displacement and retained by rehearsal. and Mitigate). if you were told that Lexus have developed a new luxury car. This enables this “knowledgebase” to handle recurrent routines. For example. Trap. but it is top secret. Flight Crew Training Centre . episodic memory gives an autobiographical view of events.Page: 41 CRM Manual Date: January 2008 Chunking has reduced this sequence to just five bits of information. 9.4 Long-Term Memory Information transfers to the long-term or permanent memory by rehearsal and repetition.6. For this reason it is normally possible to date these events quite accurately. whereas semantic memory stores similar data in a form of hierarchical tree.5 Flashbulb Memory This is a phenomenon which describes what happens when an event so incredible occurs that the information is immediately placed in long-term storage..6. This enables the brain to come up with a “sensible wrong answer”. you would be able to state with a fair degree of confidence that:     It has four wheels It has leather seats It has an amazing stereo It will be available in black and silver …. some secret? Long-term memory data is not lost. even if the correct data has never been learned. manageable by most.

Page: 42 CRM Manual Date: January 2008 Examples of events producing a “flash-bulb” effect are.7 Problems with Decision Making As powerful as it is. It is the intention in pilot training to transfer emergency drills into over-learned routines.6. the death of Princess Diana [August 1997] and the crash of Concorde [July 2000].6 Central Processor/Decision-Maker The processor in the brain is exceptionally powerful. however it is a single channel device. GPWS and Wind-shear warnings fall into this category. the explosion of the Space Shuttle Challenger [January 1986]. This prevents the cognitive functions from reaching overload and resulting inaction. Overconfidence Sunk Cost – “throwing good money after bad” Wishful thinking Outguessing Randomness Plan Continuation Error – The most significant trap that we fall into as pilots is that we find it hard to discontinue a bad approach. as they are referred to by the date itself. or we press on Flight Crew Training Centre . a response and is handled by the knowledge-base in the form of “motor-actions”. 2001 are slightly different in this respect. Common psychological traps that humans may encounter include:        Confirmation bias – only accepting evidence that confirms our position and rejecting contradictory evidence. There are other occasions where humans can do more than one thing at a time. the assassination of JFK [November 1963]. human decisions have numerous sources of bias that may hinder optimal performance. There may be occasions where it appears to be doing several tasks.6. It can only deal with one issue at a time. The events of September 11. 9. but in fact it is just switching quickly between them. this is when the action has become a learned routine. in particular responses to RTO. 9. The process tends to be dominated by vision and can only work sequentially. Availability – Solutions selected because they are available and simple to execute regardless of effectiveness.

This chapter covers the effects of stress.1 Introduction Stress may be defined as the demands that act on the human body. stress and fatigue produce similar results.Page: 43 CRM Manual Date: January 2008 towards a landing with significant issues not resolved. The term arousal will be used as the generic term for both. sleeps loss and disruption on the body and discusses techniques to manage stress and alertness. Alertness is a term used to describe the state of the body as it reacts to stress and also to describe a state of awareness.7 Conclusion The brain is exceptionally powerful but typically limited to dealing consciously with one issue at a time. It is easily overloaded and can also produce biased results. Our interest is human performance. some a combination of both. Optimum Stimulation Creativity Rationality Problem Solving Progress Under Stimulation Boredom Frustration Dissatisfaction Over Stimulation Overload Confusion Distress Flight Crew Training Centre . In this respect. This chapter highlights some of the issues now that they have been identified. Performance varies with a number of factors. others mental strains. 9. Some of these place physical strains on the body. your brain knows how to deal with them… 10 Stress and Alertness 10. including workload and circadian rhythms.

stimulation. for example. 10. Acute stress is thrilling and exciting in small doses. tension headaches. In the diagram above. Flight Crew Training Centre . into the optimum performance range (shaded). The left side of the curve shows a person in a state of under. but the time spent in these phases is relatively short. Stress is also a factor in achieving peak performance due to the release of adrenalin.2 Stress Stress is not necessarily a bad thing. A small amount of stress acts as a stimulus and results in improved performance.3 Types of Stress Stress can be divided into two types. which differs according to individuals and within individuals. is exhilarating early in the day. A fast run down a challenging ski slope. Too little stress causes complacency. consider that arousal refers to stress. The wellknown “fight or flight” or “adrenalin rush” syndromes are as a result of stress. It is preferable to remain on the left hand side of the curve. Skiing beyond your limits can lead to falls and broken bones. require the crew to be at optimal performance. such as take-off and landing. as stress increases. and other symptoms.3. overdoing on short-term stress can lead to psychological distress. As stress increases further. Initially. It comes from demands and pressures of the recent past and anticipated demands and pressures of the near future. and then falls away. acute and chronic. performance actually peaks. largely impossible. Critical phases of flight. Optimum human performance takes place in the shaded area at the top of the curve. After a certain point. within easy reach of peak performance if new demands arise. These prepare the body to react when presented with danger. Too much stress decreases a person’s ability to function. but too much is exhausting. By the same token. from being somewhat dormant.1 Acute Stress Acute stress is the most common form of stress. The right side shows over stimulation. upset stomach. performance improves. That same ski run late in the day is taxing and wearing. The body needs an optimum level of stress to operate. The American Psychological Association explains these as follows: 10.Page: 44 CRM Manual Date: January 2008 The diagram above can be used to explain the effects of both stress and fatigue and these are covered below. 10. Stress has been necessary for the evolutionary survival of the human. Sustained operation in the shaded area is however. Performance tends to degrade very rapidly if an attempt is made to remain at optimum for a long period. performance declines below optimum or satisfactory performance and enters a rapid decline thereafter.

diarrhea. The symptoms of episodic acute stress are the symptoms of extended over arousal: persistent tension headaches. stomach. however. muscular problems including tension headache. it does.3. They seem perpetually in the clutches of acute stress. a deadline they're rushing to meet. anxious. hypertension. transient over arousal leads to elevation in blood pressure. irritable. have too many irons in the fire. constipation.2 Episodic Acute Stress There are those. acute stress doesn't have enough time to do the extensive damage associated with long-term stress. migraine headaches. shortness of breath. and so on. Treating episodic acute stress requires intervention on a number of levels. The most common symptoms are:    emotional distress--some combination of anger or irritability. jaw pain. and depression. Flight Crew Training Centre . Interpersonal relationships deteriorate rapidly when others respond with real hostility. they describe themselves as having "a lot of nervous energy. sweaty palms." Always in a hurry. The work becomes a very stressful place for them. migraines. and heart disease. dizziness. and irritable bowel syndrome. their child's occasional problems at school. It is common for people with acute stress reactions to be over aroused. who suffer acute stress frequently. and can't organize the slew of self-inflicted demands and pressures clamoring for their attention. and sometimes their irritability comes across as hostility. Because it is short term. generally requiring professional help. They're always in a rush. the loss of an important contract. If something can go wrong. back pain. cold hands or feet. whose lives are so disordered that they are studies in chaos and crisis. They take on too much. and the muscular tensions that lead to pulled muscles and tendon and ligament problems. most people recognize acute stress symptoms themselves. heart palpitations.Page: 45 CRM Manual Date: January 2008 Fortunately. and it is highly treatable and manageable. flatulence. anxiety. and tense. the three stress emotions. and chest pain. acid stomach. 10. rapid heartbeat. shorttempered. they tend to be abrupt.    Acute stress can crop up in anyone's life. Often. but always late. gut and bowel problems such as heartburn. chest pain. It's a laundry list of what has gone awry in their lives: the auto accident that crumpled the car fender.

This could come in many different forms. environmental and cognitive. change in job or responsibilities (i.3 Chronic Stress While acute stress can be thrilling and exciting. More precisely. promotion to Captain). chronic stress is not. year after year.g. Chronic stress kills through suicide. of dysfunctional families. which exhibits as either a physical response e. stroke. Generally. 10. This is the grinding stress that wears people away day after day. Frequently. 10. stress is accepted as the human response to these stressors. they ignore chronic stress because it is old.4 Sources of Stress A stressor is the term used to define the cause of stress. or a mental response such as irritability.Page: 46 CRM Manual Date: January 2008 Often. of being trapped in an unhappy marriage or in a despised job or career. the symptoms of chronic stress are difficult to treat and may require extended medical as well as behavioral treatment and stress management. hyperventilation. violence. perhaps. Flight Crew Training Centre . People are immediately aware of acute stress because it is new. It wreaks havoc through long-term attrition. Chronic stress destroys bodies. 10. It's the stress of unrelenting demands and pressures for seemingly interminable periods of time. almost comfortable. a change in lifestyle is a source for this type of stress. heart arrhythmia. sweating. Chronic stress comes when a person never sees a way out of a miserable situation. minds and lives.. They blame their woes on other people and external events.3. familiar. fatal breakdown. even cancer. heart attack. It's the stress of poverty.5 Life Stress Life stress typically results from a person’s particular lifestyle. tremors. They forget it's there.3.3. the individual gives up searching for solutions. Some examples are: marriage or divorce. the illness or death of a close relative or friend. they see their lifestyle. and sometimes. There are three broad sources of stressor: life. and their ways of perceiving the world as part and parcel of who and what they are. their patterns of interacting with others.e. and. Because physical and mental resources are depleted through long-term attrition. With no hope. The worst aspect of chronic stress is that people get used to it. People wear down to a final. lifestyle and personality issues are so ingrained and habitual with these individuals that they see nothing wrong with the way they conduct their lives.

who collided with a ground vehicle whilst landing. However. Examples are the auto-brake selector instead of brake fans. The most quoted example is that of a pilot experiencing marital difficulties. His accident statement directly attributed the incident to his state of mind. 10. as their brains try to accept large and unmanageable chunks of information. The effects of cognitive stress overload are most often experienced in high workload situations. especially when it involves an operating pilot. but exposure for extended periods also causes a drop in performance. Pilots using noise attenuating headsets report less fatigue over long sectors. Temperatures in the cockpits rise rapidly on the ground during summer. Noise is an unavoidable factor with aircraft operation. either on the apron.7 Cognitive Stress Cognitive stress refers to the mental workload imposed on a person. and mismanage priorities. Noise arouses the individual. or the selecting SPD instead of HDG.6 Environmental Stress Environmental stress results from the physical environment surrounding an individual. This is referred to as “tunnel vision”.deck. humans tend to become victims of “intentional selectivity”. this will be covered later in the chapter. most pilots will experience some degree of hearing loss. but with a dissimilar function. High workload causes a skilled pilot to commit what are termed “action slips”. This is again caused by the brain trying to manage large chunks of information in short periods. In trying to complete a task and move to Flight Crew Training Centre . Suffice to say that life stress is almost definitely a threat to aircraft safety. Sleep disturbance is also a source of environmental stress. Another not uncommon consequence of high workload is the tendency to trade accuracy for speed. Two common examples could be heat and noise. These occur when a pilot follows a “motor-action” response and selects a control very similar to the desired one. as it is a mental “picture” it is extremely difficult to establish any direct causal link between life stress and an aircraft accident. The effect is that pilots will become focused on a task.Page: 47 CRM Manual Date: January 2008 Research carried out by various organizations suggests a strong link between life stress events and aircraft accidents. Noise is generated internally (radios) and externally (airflow and engine). This is caused by the limited ability of humans to process information. When workload is high. The original research was carried out by US Navy psychologists during the Vietnam era and has been expanded since. or in the flight. Heat causes a subtle and unseen form of incapacitation.3. In the long-term.3. 10.

Page: 48 CRM Manual Date: January 2008 the next. workload (physical exertion). or state of awake ness. The consequences of sleepiness are:  Decreased physical and mental performance Flight Crew Training Centre .discipline must be exercised to ensure a review is completed checking the suitability of actions performed. if we do not achieve enough sleep at the right time. After some time of being awake. self. this continues to improve performance until. Sleep quality is also affected by our body clock. Other factors affecting alertness might be the quality and/or quantity of the previous sleep (sleep debt). Jade Cargo International aircraft have advanced automation features that manage most routine tasks. but conversely a sleep debt can build up. with an inability to sleep further. 10. Getting eight hours of disrupted sleep can have effects similar to too little sleep. this can have a negative effect during the cruise. the mind and body are still in a state of drowsiness. Response time. Better quality sleep is achieved during our natural night. humans will trade off speed against accuracy. As in the case of stress. or experiencing difficulty in responding to another task is another possible symptom. For example. inactivity and a lack of interaction in a low-light environment can result in insufficient stimulation and loss of vigilance. However. A loss of sleep leads to suppressed Rapid Eye Movement (REM). Where pilots have actually assigned priorities to other tasks. The inevitable result is a slowdown in completing the task. Depending on the individual. Managing alertness is an essential skill for long-haul flying. On a night flight. The tendency is to accept a less than optimum solution to a problem. Although this can be an effective strategy. thereby inducing further errors. It cannot be stored. lack of stimulus (stress) or circadian rhythms. Sleep achieved as the body temperature starts to rise can be disrupted by mid-morning. Typically. they may become bogged down in processing the data. it may take some time before performance reaches an acceptable level. Immediately after awakening. this occurs during pre-flight where the workload is high with pre-assigned priorities. the range of optimal performance is reached. Techniques for maintaining vigilance in such a situation are similar to those for combating fatigue. a F/O may experience difficulty in calculating the take-off speeds because he feels the need to check the ATIS for the latest temperature. after reaching a peak.4 Alertness Consider that arousal now refers to alertness. Again this is caused by the inability to manage large amounts of information. leading to withdrawal effects and further disrupted sleep. This might be due to time since awake. 10. when workload is at an absolute minimum.5 Sleep Management Sleep is a vital physiological function. it starts to decline as fatigue or weariness sets in.

rather than eastbound which compresses the day. Longer term effects include depression and chronic fatigue. The typical biological clock works on a 25-hour cycle. which extend the operating day. which include:       Disturbed sleep (inability to fall asleep or stay asleep) Increased waking (work-time) sleepiness Decreased physical or mental performance Increased reports of fatigue More negative mood Gastrointestinal problems Flight Crew Training Centre . not all body functions resynchronize at the same rate. Internal refers to the different body functions being “out of sync” with each other. However. on the wrong time zone. This is known as jet-lag.6 Circadian Rhythms A well-rested individual operating within their normal circadian rhythms. the nature of long-haul operations means that pilots are more often than not. this can leave the pilot somewhat disoriented for several days after a trip involving several time-zone changes. neither well rested nor within their circadian rhythms. Stress and fatigue combine to pose a significant challenge to airline operations. will have little problem achieving optimal performance at short notice should it become necessary. Following the disturbance of a time-zone change. It is kept synchronized on a daily basis by exposure to bright light and regular social interaction. External refers to the body being “out of sync” with the environment. Knowing how to combat the ill-effects caused by these factors is an acquired skill that needs to be practiced actively by the modern airline crewmember. The longer body-day also makes it easier to adjust to time zone changes on westbound routings. sleep is deeper rather than longer. An individual with a significant “sleep-debt” (accumulated sleep disruption) is often irritable. Shift-work has similar effects to jet-lag. inattentive and has an increased reaction time. 10.Page: 49 CRM Manual Date: January 2008    Decreased positive and increased negative mood Increased vulnerability to performance decrements Following sleep loss. Jet-lag can be described as external or internal.

10. This acts as an effective fatigue prevention tool and allows a satisfactory level of alertness to be maintained. the Flight Crew Training Centre .2 Levels of Situation Awareness (SA) “Endsley” has produced the commonly accepted definition of situation awareness as: “The perception of the elements within a volume of time and space. Exercise is often used as a form of stress relief. who has it and the skills necessary for maintaining and sharing situational awareness. Others prefer mental stimulation. when conducted in a structured fashion. this is a potentially dangerous practice. 11. is the duty of every crewmember.1 Introduction Situational awareness is frequently stated as a factor in accidents and incidents. This practice is based on extensive research done by NASA among others.7 Stress and Alertness Management The FOM requires pilots to be in good physical and mental health – fit for duty. As any medical practitioner will verify. In the modern world. with dire consequences in the aviation industry. 11 Situational Awareness 11. The duration of rest is limited to prevent sleep inertia. a staggering 88% have been identified as involving a loss of situational awareness. circadian disrhythmia is not sufficient cause to cease operations. It is another warning flag.Page: 50 CRM Manual Date: January 2008 Circadian Rhythms As with the other threats that we face. 10.8 Controlled Rest in the Flight Deck The FOM also provides for controlled sleep during low workload situations. In accidents involving human error. It has proven that controlled rest is a very effective tool for combating fatigue and maintaining alertness. This chapter will explain what it is. providing awareness and in need of management. Managing stress and sleep effectively. The use of alcohol is not recommended as a form of stress relief. However it is often quoted without really being explained. In extreme cases this can take the form of dangerous sports. computer games appear to be increasingly filling this role. The use of card and board games has historically been a popular form of stress relief.

In addition to three levels of SA. those with normally high SA tend to recognize when they are losing SA. but what it means is that there are three levels of situational awareness. passengers and company). 11.3 Loss of Situational Awareness Individuals have differing levels of situational awareness. the environment (terrain and weather) and the people (ATC. there are different domains that must be monitored by the pilot. The pilot must monitor the aircraft (flight-path. and Communicate. The Importance of Situational Awareness Now that we know what SA is. but it guides our selection of goals by providing understanding and projection. crew. It is not just enough to notice a situation. fuel and time). why is it so important? Situational awareness is considered to be the driving force behind good decisions. systems.” This is quite complex. then our decisions will be well founded and good performance will follow. The problems with SA in accident cases have mostly revolved around pilots failing to notice! Figure 1: Levels of Situational Awareness The key to situational awareness knows what comes next.Page: 51 CRM Manual Date: January 2008 comprehension of their meaning and the projection of their status in the near future. In a well-known phrase: Aviate. one must understand and think ahead. automation modes. which mitigates part of the problem. Situational Awareness + Decision-Making = Performance SA is our current “mental mode” and not only directs attention where required. Flight Crew Training Centre . If we are aware of all the relevant factors (good SA). Navigate.

etc Failure to adhere to standard operating procedures Failure to comply with limitations. identified that most of the consequential and additional errors occurred during the descent and landing phase. regulations etc Failure to resolve discrepancies . Results from observations at several different airlines. After descent initiation. Additional errors should be guarded against as these could lead to an error-chain forming. Prior to descent. Avoiding error is the initial course of action. there is much to be concerned about here. Mitigate” is one solution to the problem.vague or incomplete statements 11.descent and leads up to the approach. Jade Cargo International uses the concept of the “Safety Window”.focusing on any one thing to the exclusion of everything else Confusion . less time is available for noticing and avoiding. A three-stage model “Avoid.contradictory data or personal conflicts Failure to communicate fully and effectively . Trap. during the take-off and landing phases. Since historically over 70% of accidents have occurred in this phase.4 The Safety Window Reviews of accident trend data continue to indicate that most accidents occur close to the ground. Flight Crew Training Centre . fixation and confusion exist. The philosophy is to stay out or get out of the safety window where ambiguity. clear briefings and good communication should take place to achieve this.information from two or more sources that doesn't agree Fixation . fuel burn. When below 2000’ AGL (approximately 7nm from the airport) there is limited time to troubleshoot an unresolved problem. These may indicate that an error chain is in progress. The trapping phase begins at top-of. minimums. Most accidents involving human error include at least four of the following:           Ambiguity . if potential problems can be identified in time. In fact most are within seven miles of the airport. so the emphasis should switch to trapping any errors that do occur. fixation and confusion.uncertainty about a situation (often accompanied by anxiety or uneasiness) Failure to fly the plane: everyone is focused on non-flying activities Failure to look outside: everyone heads down Failure to meet expected checkpoint on flight plan or profile-ETA.Page: 52 CRM Manual Date: January 2008 Clues that indicate a possible loss of SA are ambiguity.

task management and prioritization. Consider the case of an unexpected tailwind on approach. identified by the PM: PM: “Looks like a 15 knot tailwind on approach” This is shared perception – they have noticed the problem PF: “OK.” Flight Crew Training Centre . perceptual speed and working memory capacity are inborn. Human error is inevitable. Skills relating to spatial ability. too fast etc) must be avoided. and use the speed brake if necessary. this may indicate they are operating at understanding [Level 2 SA]. if mitigation seems to be the key factor.e. potential problems that are identified early allow the opportunity to avoid.6 Factors Affecting Situational Awareness Studies have revealed a ten-fold difference in SA between pilots within the same airline. unstabilized approach. If the crew is trapping a lot of errors. 11. It has also been observed that crews flying non-glass aircraft have better SA than those with the latest technology. Should such a state occur. scan patterns and checklist use. Information can be shared at all three levels of SA.5 Situational Awareness and Error Management Using “Threat and Error” management principles. Advanced skills include pre-flight planning. Basic skills that high SA crews exhibit are. 11. communications. there is very little time left to correct it. Situational awareness can be trained to a certain extent. contingency planning. an undesired aircraft state (i. 11. otherwise crew SA tends to fall to that of the weaker crewmember. The best strategy is to “Mitigate” the problem by going-around. self-monitoring. PM: “They might change runways if the surface wind picks up. psychomotor skills and pattern matching are trainable.Page: 53 CRM Manual Date: January 2008 In the final stages of the approach. Finally. attention-sharing.” This identifies shared comprehension – the PF understands. we can make the link to identify at which level of SA we are operating at. indicating that the crew is thinking ahead [Level 3 SA]. By analyzing how we deal with the problem. then the crew is only noticing problems [Level 1 SA]. The Mitigate phase commences at the start of the Safety Window (2000’ AGL). I’ll reduce speed xx miles earlier than briefed. so that we can take action to improve it. too high. However.7 Communication Awareness and Shared Situational For a crew to be most effective they must share the same high SA.

8 Techniques for Better Situational Awareness Management           Predetermine crew roles for high-workload phases of flight. Solicit input from all crew-members including cabin. Flight Crew Training Centre . dispatch. It is essential to confirm a level of understanding when communicating at the perception level.don't fixate. Typically crews are comfortable with “perception” level communication. Develop a plan and assign responsibilities for handling problems and distractions. Create visual and/or aural reminders of interrupted tasks Watch for clues of degraded SA. etc. Project ahead and consider contingencies. maintenance. ATC. but for various reasons feel inhibited in offering more processed information for fear of offending the other pilot. Speak up when you see SA breaking down. The response “Ok” is no guarantee that the other pilot has even noticed – he may just be acknowledging that you have stopped speaking! 11.Page: 54 CRM Manual Date: January 2008 This is shared projection – they are thinking ahead. Rotate attention from plane to path to people . Focus on the details and scan the big picture. Monitor and evaluate current status relative to your plan.

Colombus. & Sherman. Paper presented at the SAS Flight Academy Training Conference. A. November 20-24. Taggart. April 23-25.L... New Zealand. Local solutions for global problems: The need for specificity in addressing human factors issues. Columbus: Ohio State University. April-May. 1997. A. what is it? (Error. (1995).C. & Helmreich. November 26-28.L. Merritt. Cultural influences on flight operations.S. Designing culturally sensitive CRM training: CRM in China. A..L. (1997). Guangzhou... Auckland. A. (1996).. R. 1991..1 (USA/Anglo) (Technical Report 96-4). Helmreich.. Ooi. & Helmreich. Paper presented at the IXth International Symposium on Aviation Psychology. Merritt. Merritt. 1. Ohio. R. In proceedings of the VIIIth International Symposium on Aviation Psychology. Merritt. (1995).L. (1995). (1996).J. University of Texas: Aerospace Crew Research Project. CRM Advocate.C..C. Colombus. Creating and sustaining a Safety Culture. April. Merritt. stress. Paper presented at the ICAO Global Human Factors Seminar.R. R.C. 1996. 8-12. (1997). Merritt. (1996.C. Paper presented at the IXth International Symposium on Aviation Psychology. Ohio.0 (International) & 2. The Aerospace Crew Research Project Line-LOSChecklist: Assessing system safety and crew performance. Sydney.. & Helmreich. 1995. A.C.A..C. (1996). R. A. Indonesia. & Merritt. A. May 1995... Replicating Hofstede: a study of pilots in eighteen countries.L.R. (1991). April-May. 1996. Wilhelm.L. J.C.C.. W. Cultural issues in crew resource management. and culture) Paper presented at the Orient Airlines Association Air Safety Seminar. R. & Merritt. R. Flight Crew Training Centre . Jakarta. CRM in 1995: Where to from here? In Proceedings of the Third Australian Aviation Psychology Symposium.. P.Page: 55 CRM Manual Date: January 2008 12 Reference Notes Helmreich. 1997. April). Flight management attitudes questionnaire 2. Paper presented at the Training and Safety Symposium. Helmreich. CRM: I hate it. T. A. P.