March 2, 2022 | Mark Paradies

Hearing Warnings: The Need for Senior Executives to Listen and Respond to Signals that Indicate Unacceptable Risk

Vice Admiral Joseph Aucoin Sent Warnings

Vice Admiral Joseph Aucoin (Retired)

Hear Warnings: The title of this article is the title of Admiral Aucoin’s talk at the 2022 Global TapRooT® Summit. Did the chain of command not hear the warnings (some say they don’t remember them). Or did they just not act?

Management often wants something for nothing. They

  • Delay maintenance because they want to cut costs.
  • Eliminate training because things seem safe enough.
  • Ask people to do more than is possible and ignore the shortcuts that become commonplace.
  • Reduce staff to way below what is needed causing fatigue and stress that leads to mistakes.

What happens when a major accident happens? Ask Retired Vice Admiral Joseph Aucoin. He was the head of the 7th Fleet when, within nine weeks, two DDGs collided with two merchant ships.

After 17 sailors died and two ships were disabled, the story from the top leadership was it was bad sailors with bad leadership on those ships. The Commanding Officers faced Court Martials. Officers had letters of admonishment put in their records and were released from service. But were the real root cause identified? Were effective corrective actions implemented? Can a blame focus and effective root cause analysis go together?

Before you attend the 2022 Global TapRooT® Summit to hear Admiral Aucoin discuss these issues, you should read:

ProPublica article by Robert Faturechi, Megan Rose, and T. Christian Miller

Years of Warnings,
Then Death & Disaster
How the Navy Failed its Sailors

By Robert Faturechi, Megan Rose
and T. Christian Miller

The article states:

The risks were obvious, and Aucoin repeatedly warned his superiors about them. During video conferences, he detailed his fleet’s pressing needs and the hazards of not addressing them. He compiled data showing that the unrelenting demands on his ships and sailors were unsustainable. He pleaded with his bosses to acknowledge the vulnerability of the 7th Fleet.

Aucoin recalled the response: “Crickets.” If he wasn’t ignored, he was put off — told to calm down and get the job done.

Hear Warnings: A Story for All Senior Executives and Leaders

PhDs call the warning that the article calls obvious, “weak signals.” But for those that understand what makes a particular business tick, the signals should be shouting to knowledgable senior executives.

I often think that the signals aren’t weak. Rather, senior leaders don’t want to hear the warnings. If you read the well-researched article by Robert Faturechi, Megan Rose, and T. Christian Miller, I think you will agree.

A maverick admiral, Hyman Rickover, called acting upon these weak signals “Facing the Facts.” He defined facing the facts as:

“… To resist the human inclination to hope that things will work out,
despite evidence or suspicions to the contrary.

He insisted that leaders in the Nuke Navy face the facts. He said:

If conditions require it, you must face the facts and brutally make
needed changes despite significant costs and schedule delays. …
The person in charge must personally set the example
in this area and require his subordinates to do likewise.

Rickover personally took the risk to his own career by facing the facts to ensure nuclear safety. (See the stories in this article.) But this ability to hear warnings and insist that others hear them as well was not common in the rest of the Navy (outside the Nuclear Navy).

But do these weak signals only happen in the Navy? You might think weak signals don’t happen in the commercial industry. Certainly, senior executives in industrial settings carefully measure risk and demand their subordinates avoid needless risk. They are much more safety conscious and don’t think like warfighters.

Sorry. There are many examples outside the Navy of senior executives encouraging non-conservative decisions. Read the articles below for just a few examples of non-conservative decisions, failing to hear weak signals and the trouble that can result…

That should be plenty of examples to convince you that CEOs, Directors, VPs, and Plant Managers often ignore the facts and make non-conservative decisions.

What Can YOUR Senior Executives Do to Hear Weak Signals, Face the Facts, Make Conservative Decisions, and Stop Needless Accidents?

First, they should read the seven-article series about Admiral Rickover’s leadership lessons. See:

But simply reading a series of articles isn’t enough.

Next, they should attend the pre-Summit course, TapRooT® Executive Leadership Course (May 2-3 in Knoxville, TN). This course includes a discussion on conservative decision-making and an exercise where the executives in attendance evaluate an incident and identify non-conservative decisions. That’s the first step in evaluating their own decisions.

Also, the course will allow your senior leaders to network and benchmark with other senior leaders so they can evaluate their company’s decision-making and root cause analysis practices.

Keynote Speakers

Finally, they need to register for the Executive Leadership Track at the 2022 Global TapRooT® Summit being held in Knoxville, Tennessee, on May 4-6. They will learn at all of the Best Practice Breakout Sessions but also from the five Keynote Speakers.

My belief is that hearing the talk by Admiral Aucoin and perhaps even having an after-hours discussion with him will be a life-changing event.

Start the process of stopping fatalities and major accidents. Start the process of making conservative decisions. Pass this article on to your senior executives and get them registered for the TapRooT® Executive Leadership Course and the Executive Leadership Track at the 2022 Global TapRooT® Summit on May 2-6 in Knoxville.

CLICK THIS LINK to get the registration process started.

Operational Excellence, Process Safety, Safety, Summit
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