3. Creating A Culture For Learning

Question 1

__ __ an action selected during the critical event, was the deciding factor that led to the crash death or injury. p25

Answer 1

Decision point

Question 2

Complacency occurs when the organizations mission becomes unclear or is not reinforced and the condition called __ of __ develops. p27

Answer 2

Normalization of deviance

Question 3

Note

Post-incident analysis- the individuals conducting the analysis understand that no single account is the one true story of what happened

Answer 3

Minimize the chances, impossible to eliminate all factors

Just culture

Question 4

In a healthy CRM environment complacency is ___. p28

Answer 4

Uncommon

Question 5

When the younger team members are influence to Deviate from protocol or standards by veteran crewmembers, it is termed ___ ___. p28

Answer 5

Veterans bias

Question 6

Admitting in error should be a non-___ event within such a system. p30

Answer 6

Non punitive

Question 7

___ ___ ___ typically begins with asking each person involved to write down his or her perception of the incident. p31

Answer 7

Systemic cause analysis

Question 8

Systemic cause analysis categories: p31

Answer 8

System influences

Education and training failures

Circumstances beyond the operators control

Human factor

Question 9

Once the appropriate reports, pictures, policies, training records, best practices documents, and interview notes have been gathered, the next step is to build a ___ ___. p31

Answer 9

Incident timeline

Question 10

A database that contains information collected in- near miss accounts. p32

Answer 10

Trend files

Question 11

As was mentioned earlier, implementing an open communication model such as CRM first requires that a solid __ __ be built. p25*

Answer 11

organizational culture

Question 12

__ of __ is a long term phenomenon in which individuals or teams repeatedly accept a lower standard of performance until that lower standard becomes the norm. p 27

Answer 12

Normalization of Deviance

Question 13

Best practices for developing self-reporting systems include the following: Forms ___ p32

Answer 13

forms can be anonymously completed
forms use a standardized set of questions
forms create a foundational database
forms developed so data can be entered into large national databases

Question 14

Once an organization has developed a process for analyzing errors and accidents in a systematic fashion, it is helpful to create a method for individuals to __ __ their errors and near misses. p 32*

Answer 14

self-report