News item: (USA Today) Box-cutters (more then one) fell out of a man’s carry-on luggage as he stowed a bag in the over head at NYC’s JFK, on a flight to the Dominican Republic.  The screeners were not fired, but sent for retraining.

“In case anyone has forgotten, the TSA was created because of a couple boxcutter incidents,” one unnamed Port Authority said.

The question has always bothered me: When does an individual failure become a systemic failure?

I’ve studied this in labor intensive American manufacturing where profit was the motive.  I’ve studied it in Soviet style manufacturing where profit was not the motive. I’ve talked with workers, without observation, in large postal processing facilities, and I’ve observed up-close one for-profit operation which I’ll mention later.

In all of them, extensive records are kept, i.e., number of failures, types of failures, usually measured in per cent of total items handled, and often, as in military contracts where I consulted, also according to criticality. For instance, people who make web belts for the military have a lower standard of criticality than a parachute manufacturer. Even box cutters have been down-graded as they, while dangerous, are no longer thought to be able to bring down an airliner.

In a line of 20 people doing a collection of tasks if one person makes a mistake, it is an individual mistake. If  as few as three in that line make that mistake there is probably a systemic failure, a failure in process. It needs to be redesigned. If that one person makes a mistake, is written up, receives retraining, and then makes the same mistake again…and is not fired or removed…the failure becomes systemic. There is a failure in the management system.

With Wisconsin teachers in the news, we already know just how systemic is the failure of American public schools, both in process design and management design, top to bottom. Yet the public debate is about protecting the existing “for-profit” aspects of those failed designs, for some people obviously profit from this disastrous system.

But TSA is also in the news, for they are also considering organizing into a public workers union…a union that will, by nature and design, lock in the same sort of inefficiencies and failures that have eaten up the school systems.

In terms of criticality, can we afford this? Both of these professions carry a high degree of criticality…schools today very much like the parachute that won’t open…in Wisconsin where 64% won’t open, i.e., 8th graders who can’t read proficiently. And no one really needs to explain the criticality of 2 million people each day placing their lives in the hands of crews of sometimes aware, sometimes indifferent screeners…once they are protected from sanctions for bad work.

Examining TSA tracking numbers don’t tell us much for there are no other standards to compare them to, in part because there’s no way to tell us how many dangerous items slipped through their screens. (Some random tests have shown a high degree of laxity, however, just Google “guns slip through TSA screens”.) What we do know is that too many items, such as the box-cutters, are discovered by pure luck, just as the Detroit underwear bomber was thwarted by passengers.

I’m sure everyone here can suggest fixes. I for one like turning the ‘”for-profit” motive over to the teachers and screeners and taking it away from the unions. In the teaching profession, it’s called “merit pay”.

This would be more difficult with TSA screeners, but if I wanted to find the best crew-workers to teach top quality attention processing in a fast-paced, noisy, hectic, work environment, I’d send the best pit crew at the Venetian Casino in Las Vegas working the crap tables at 11 PM  on Saturday night (total mayhem), the other working the tables at 4 AM on Wednesday at the Showboat in Atlantic City (sleepy time gal). Now that’s professionalism.

 

vassarbushmills
Citizen With Bark On