Culture at Work in Aviation and Medicine

National, Organizational and Professional Influences

Robert L. Helmreich, Ashleigh C. Merritt

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781351946810
• Edition: 1
• Topic: Technology & Engineering
• Subtopic: Aviation
• Index: Technology & Engineering

Culture forms a complex framework of national, organizational and professional attitudes and values within which groups and individuals function. The reality and strength of culture become salient when we work within a new group and interact with people who have well-established norms and values. In this book the authors report the results of their ongoing exploration of the influences of culture in two professions - aviation and medicine. Their focus is on commercial airline pilots and operating room teams. Within these two environments, they show the effects of professional, national and organizational cultures on individual attitudes, values and team interactions. From the Foreword by Captain Daniel Maurino: '...the authors direct their attention to applied research as well as to the search for practical tools to approach and deal with the relationship between culture, error and error management, and between culture and aviation human factors training for operational personnel. They devote particular attention to the link between culture and Crew Resource Management (CRM) training, a safety and prevention tool towards which few if any have contributed so much and so well..' '...The incorporation and management of cultural factors into aviation operations and practices simply represent another tool to contribute to the aviation system's production goals. Encouraging progress has been made, but there is need for improvement. This book presents one possible way to move forward' Vividly laced with numerous contributions from a range of practitioners and researchers from Asia, Australia, Europe and the Americas, as well as case studies and practical examples, the book is designed to be accessible to practitioners and managers wishing to improve their own organization and to researchers with an interest in gaining a greater understanding of the types of culture.

1 Groups and Cultures in Aviation and Medicine

The great tragedy of Science – the slaying of a beautiful hypothesis by an ugly fact. (Thomas Huxley, Biogenesis and Abiogenesis, 1870)

Culture fashions a complex framework of national, organizational and professional attitudes and values within which groups and individuals function. The power of culture often goes unrecognized since it represents ‘the way we do things here – the natural and unquestioned mode of viewing the world. However, the reality and strength of culture become salient when we work with a new group (whether in a new country, a new organization or a new profession) and interact with people who have well-established norms and values.

We report here the results of our ongoing exploration of the influences of culture in two professions, aviation and medicine. Our focus is on commercial airline pilots and operating room teams. In both of these domains, work requires high levels of interpersonal collaboration, communication and coordination. The fact that teamwork is an essential element of these domains is both an advantage and a disadvantage for the investigator. Research is facilitated by the fact that group interaction and communication can be observed and measured. However, the dynamics of multi-person interactions are highly complex and are difficult to decompose and understand. As a result, the study of group behavior has lagged behind other areas of psychology.

The study of culture poses its own set of challenges. Culture is an abstract construct that must be inferred from behavior, self-report and artifact. In our case, we are interested in three types of cultures – those associated with national heritage, with organizational membership and with professional allegiance. In this chapter we discuss methodological issues surrounding the study of groups and their behavior and provide the reader with an overview of the work environments we have studied in aviation and medicine.

The Methodological Morass of Group Research

The investigator interested in group behavior must answer two important questions: should I conduct my research with natural groups in a field setting or in the laboratory, and should my investigation be correlational or experimental in nature? The problems facing the field investigator are daunting ones. Natural groups function in real settings where behavior is determined by multiple factors outside the control of the investigator. Studies in the natural world are more likely to deal with correlations among variables that are embedded in a highly complex environment. In correlational group research the inability to specify causal relationships is a major barrier to understanding. However, the experiment poses its own set of methodological problems.

The prototypical social psychological experiment on work groups examines the behavior of ‘pseudo-groups’ of undergraduates formed in the laboratory to work briefly on a relatively meaningless task (Helmreich, 1975; 1983).¹ Unlike correlational research where causality is necessarily indeterminate, the laboratory experiment, where the researcher can control and manipulate conditions, allows clear specification of causality. However, ethical constraints preclude using powerful or long-lasting manipulations with experimental subjects. In contrast, ‘real’ work groups typically have a considerable lifespan and the efforts of participants are highly consequential. Performance of the group’s tasks often determines success in terms of pay and promotion and, in military and other hazardous environments, may determine life or death. Given the limitations of the laboratory, it seems unreasonable to assume that most findings from laboratory groups can be generalized in meaningful ways to the workplace.

After considering the trade-offs, we concluded that meaningful data in our areas of investigation could only be acquired in real work settings. Despite the real limitations of field research, it is our belief that lack of control can be largely offset by replication in diverse settings and through the use of multiple measures of constructs and behaviors. Thus our commitment is to the study of groups in natural settings.²

The decision to study natural groups in vivo was further reinforced by consideration of what was known as the ‘crisis in social psychology’ during the late 1960s (McGuire, 1967; Ring, 1967). Kenneth Ring, one of the harshest critics of academic social psychology, argued that theoretical social psychologists avoid the study of fundamental social issues while pursuing theoretical problems of little or no import. The acrimonious exchanges that dominated professional meetings during this era degenerated into a schism between those doing applied research and those committed to theoretical inquiry in social psychology. Members of each faction openly questioned the values and contributions of the other. Such polarization seems ironic since Kurt Lewin (1946), who is acclaimed as the intellectual father of modern social psychology, followed a strategy that he called ‘Action Research’. Action research pursues theory development and application as complementary goals. Investigation of important social issues is not inconsistent with the development of basic theories of social behavior. It is our conviction that the study of natural groups engaged in meaningful work provides the opportunity for both pursuits.

At the same time that we committed the project to naturalistic, action research, we initiated a research philosophy that endures today. In exchange for access to their operations for research, we provide participating organizations with detailed feedback on findings about their operations and make recommendations for action. Organizations, in turn, agree that data collected can be published in de-identified form and share in funding the research.

Box 1.1 From the bridge to the classroom to the cockpit

I was commissioned as a line officer in the US Navy after graduating from Yale University with a major in Culture and Behavior, which included Anthropology, Biology, Psychology and Sociology. My honors thesis had been on the physiological effects of stress, reflecting an early interest in reactions to extreme environments. I served on destroyers in operations and as officer of the deck for combat and refueling. The period of the 1960s when I was on active duty was one of heightened international tensions. It included the Cuban Missile Crisis, the building of the Berlin Wall and the onset of conflict in Southeast Asia. Serving on destroyers on deployments of six or more months served to focus my interests on the behavior and performance of groups living and working under stressful conditions. Observing and experiencing the diverse responses of shipmates, including peers, subordinates and superiors, convinced me that research into group behavior should be at the heart of my graduate studies.

After completing my active duty service, I returned to Yale and enrolled in the PhD program in personality and social psychology. My early graduate research involved the study of undergraduates exposed to modest levels of stress in the laboratory. It became apparent to me that the reactions of students to the stressors imposed in brief experimental sessions were probably not representative of those of groups exposed for long periods to life-threatening events such as combat.

Fortunately, because of my military and diving background, I was able to conduct my dissertation research as a field study of the reactions of aquanauts living and working on the ocean floor under extremely hazardous conditions as part of the Navy’s Project Sealab (Radloff & Helmreich, 1968). This experience convinced me that some aspects of human behavior, including reactions to prolonged and high stress, must be studied in natural settings.

After completing my dissertation, I joined the faculty at The University of Texas at Austin. My research in performance and adjustment under stress was supported by the Office of Naval Research and NASA. NASA’s goal in sponsoring this research was to generate data relevant to selection, training and management of long-duration spaceflight. This included further investigations of the performance of aquanauts living and working in habitats on the ocean floors (Bakeman & Helmreich, 1975).

A serendipitous event changed the research setting dramatically. NASA, of course, is the National Aeronautics and Space Administration. As part of its efforts in aviation in the 1970s, scientists at NASA’s Ames Research Center investigated the causes of jet transport accidents and came to the then startling conclusion that human error was a root cause of the majority. In 1978, NASA hosted a workshop for the aviation industry to share these findings and I was invited to give the keynote address on social psychological factors in the cockpit (Cooper, White, & Lauber, 1979; Helmreich, 1980). Representatives of several of the airlines present felt that the research approach described was as relevant to aviation as to space and invited our group to study pilot behavior and performance in their organizations. From this almost casual beginning, a project that is now in its nineteenth year was born.

An equally serendipitous event led to the current research with medical teams. A Swiss anesthesiologist, Hans-Gerhard Schaefer, saw the links between medicine and aviation and introduced me to a remarkable environment with daily life and death encounters.

A major theme underlying my career is the commitment to research that addresses social issues as well as theoretical concerns. Both aviation and medicine provide settings where research has the potential to increase safety and save lives. (Robert Helmreich)

Box 1.2 From Oz³ to Austin: an Australian discovers culture

I was born and raised in Australia, and completed my undergraduate and honours studies in organisational psychology at the University of Queensland. I lived in London for two years some years ago, and came to understand some of the English influence upon Australia. When it was time to do my doctoral work, I decided to go to the USA so that I could study Americans ‘up close’. Along with England, the USA exerts a strong cultural influence on Australia, and I wanted to understand how a country that was populated by Anglos at about the same time as Australia, could have developed so differently from Australia. For example, Australians are blessed and handicapped with the ‘tall poppy syndrome’, a tendency to cut anyone back down to size who tries to stand out too far from the other flowers in the field. Based on my observations of the last eight years in the USA, I believe Americans embrace the opposite syndrome, which I call ‘I’m special’. This national belief system seems to blend self-esteem with entitlement, allowing individuals to believe that they are worthy of special consideration – a whole nation of tall poppies if you will. (To avoid a clamor of complaints, let me state that, yes I honestly believe that each value system has its advantages and disadvantages.)

It was chance and good fortune that brought me to Bob Helmreich’s door-we bonded on our mutual distrust of psychology studies conducted in laboratories with psychology undergraduate students. With Bob’s help and guidance, I navigated my way through a study of national culture and pilots’ attitudes, and much of the material in Chapter 3 is based on my doctoral dissertation. The more we delved into national culture, however, the more we realized the story was not that simple, and we began to look more closely into organisational culture, and later, professional culture. Understanding the complex interactions of these cultures has proved to be a fascinating research arena. (Ashleigh Merritt)

The Research Environment

In this section we describe relevant characteristics of the cockpit and operating room (OR) environments. We then consider the similarities and dissimilarities of these domains and, finally, evaluate them as research venues.

The Cockpit

Commercial jet transports are operated by a crew of two or three pilots, depending on the design and level of automation present.⁴ Pilots are qualified and licensed professionals who perform the same duties in every nation and organization. During flights, crews operate as semi-autonomous work groups, responsible for the conduct of the mission. They also have responsibility for coordinating and directing the activities of the cabin crew.

Although separated from their company and its management, crews do not operate in a vacuum. They are members of an airline that has formal rules governing the conduct of their jobs. Their flights are conducted as part of a complex and regulated aviation system that has formal rules for the operation of aircraft. The specific direction of flight is coordinated by air traffic controllers who issue commands by radio regarding navigation, speed and destination, based on formal flight plans filed by each company. During flight, crews must also coordinate their activities by radio with their company’s flight operations department.

Helmreich & Foushee (1993) proposed an input-process-output model of flight crew performance that is shown in Figure 1.1. The model illustrates how the behavior of pilots in the cockpit is influenced by a variety of input factors, including individual attitudes, values and capabilities, and organizational and environmental conditions. Influenced by the multiple input factors, the crew conducts a flight through processes that include both technical tasks, such as controlling the aircraft, and team responsibilities, including communications, decision making, task allocation and planning. The desired outcomes of a flight are safety and efficiency (along with the comfort of passengers), but the dynamics of interactions also shape and interact with the attitudes and morale of the crew members. These, in turn, become inputs to processes in subsequent flights. Thus the model is both dynamic and recursive.

The aviation system is very safe and the overwhelming majority of flights are routine and without incident. However, even on a routine flight the crew’s workload varies greatly. Both departures and landings involve the accomplishment of numerous tasks simultaneously. These include monitoring aircraft systems, completing checklists, re-viewing approach and departure charts, listening for and answering radio communications, looking for other, conflicting traffic, and coordinating cabin crew activities. Multi-tasking is a demanding and important aspect of team performance in the aviation environment (Waller, 1997; Waller, in press).

Source: Adapted from Helmreich...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• List of Boxes
• List of Figures
• List of Tables
• Foreword
• Preface
• Notes on the Contributors
• 1 Groups and Cultures in Aviation and Medicine
• 2 Professional Culture
• 3 National Culture
• 4 Organizational Culture
• 5 Error Management: a Cultural Universal in Aviation and Medicine
• 6 Implementing Error Management: Trust, Data and Interventions
• 7 When Cultures Collide
• 8 Cultural Psychology: a Synthesis
• Appendix A Methodological Issues in Cross-cultural Research
• Appendix B Data
• Appendix C Research Instruments
• References
• Index