Challenger: Case Study in Engineering Ethics and Communications - PowerPoint PPT Presentation

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Challenger: Case Study in Engineering Ethics and Communications

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  1. Challenger: Case Study in Engineering Ethics and Communications Tom Rebold Adapted from Tufte, Visual Explanations And http://www.footnote.tv/mwchallenger.html

  2. The IncidentJanuary 28, 1986

  3. The Investigation

  4. O-Rings were a known problem • 1970’s: less safe than more expensive alternative • 1985: scorching becomes noticeable • Thiokol analysis shows worse on colder days • Launch constraint by NASA (waived every launch) • Thiokol Engineer Roger Boisjoly warns superiors “we could lose a flight” • August ’85: NASA Meeting, no changes • Later, Feynman calls this strategy “Russian Roulette”

  5. Night Before Launch • Boisjoly and others: “too cold, delay launch!” • Until 53ºF • Management: how come some warmer launches show scorching? • (crucial fact ignored--every single launch in cold temperatures showed damage) • Thiokol management gets the engineers to accept a launch recommendation.

  6. Role of Communications Chart used by Thiokol Engineers on Jan 27 before launch

  7. A Revised Chart by Rogers Commission Showing all launches Temperature at Challenger Launch, 32ºF

  8. Obfuscation during investigation • Famous physicist Richard Feynman performs experiment on television • Dips o-ring in ice-water • Shows greater stiffness • also complains about slides, bullets • Edward Tufte, designer • Provides further damning analysis of charts • Condemns PowerPoint

  9. Another Communication Problem • Decisions • Knowledge of details

  10. Epilogue • Several families sued NASA management • between $2 and 3.5 million per family. • Morton Thiokol paying 60 percent • Roger Boisjoly, Thiokol engineer • testified before Congress • sued Thiokol under a federal whistleblowing statute (lost) • left the company • underwent therapy for post-traumatic stress disorder • awarded the Prize for Scientific Freedom from the AAAS, • now lectures on workplace ethics issues (in Australia) • Thiokol gave up $10 million incentive fee • did not sign a document admitting to legal liability. • NASA bans commercial or military payloads from shuttle • launched on unmanned rockets