![]() In this case, the space shuttle broke apart just after launch the Challenger facility (STS 51-L) at Cape Canaveral is captured as the location for the incident. While other Cause Map diagrams related to space disasters technically describe an incident that occurs in two locations (at the space shuttle and command center), the emphasis remains on the location that can be controlled: the command center. In addition to capturing a specific time, we also need to capture the specific location when defining the problem for the root cause analysis. Here, the Challenger broke apart two minutes into its 10th mission, at 11:39:12 AM EST on January 28, 1986. In order to measure change, specify as precise of a time as possible for the given incident. For this example, we identify the loss of all seven crewmembers and the loss of the space shuttle as the major problems. Avoid arguments and write down all of the potential problems for later evaluation. In investigating any incident, big or small, the process of specifying the problem is likely to elicit multiple responses. We do so by asking four critical questions: What Is the Problem? The first step in any root cause analysis approach is to define the problem. (In fact, an estimated 85 percent of Americans heard about the disaster within the hour it happened.) Step 1: Define the Problem with Four Questions ![]() For NASA, was a catastrophic event on several levels: seven colleagues lost their lives a multimillion-dollar space shuttle was destroyed and the good public relations NASA hoped to garner was ruined. But 73 seconds after liftoff, the space shuttle broke apart over the Atlantic Ocean, taking the lives of all seven crewmembers. Accordingly, there were more media present on that morning with below-freezing temperatures in Cape Canaveral, Florida as millions of people around the world watched.Īt the time, the Challenger was the most-flown orbiter in NASA’s fleet. The program was an effort to get the public invested in the space program while signaling that space travel was becoming more normal and accessible. Schools around the country tuned in for the liftoff. Chosen from more than 11,000 other candidates, Christa McAuliffe had planned to give lessons from space. It was the first voyage of the new Teachers in Space Project-the first flight on which someone who was not a trained astronaut was permitted to travel into space. The launch of the Challenger the morning of January 28, 1986, was a momentous occasion, even for a shuttle well versed in historic firsts. An Exciting First Becomes Tragic on Live TV For this case study, we’re using the Cause Mapping ® method of root cause analysis to better understand what happened on the ill-fated 10th flight and evaluate how the risk of a similar incident could be reduced. Unfortunately, its 10th flight marked another first-NASA’s first space shuttle disaster. Throughout its subsequent missions, the Challenger also carried the first African American, Canadian and Dutchman into space. Two months later, Sally Ride became the first American woman in space. Its maiden flight in April 1983 witnessed the first spacewalk during a space shuttle mission. Fiction? We were killing time on the Atari until the real 21st century arrived.The Challenger space shuttle made history repeatedly. We drank Tang from Apollo commemorative glasses and ate Space Food Sticks and rolled our eyes at the quaint reruns of Buck Rogers and his fictional 21st century. What had been a primal myth for all previous generations of humanity was presented to us on the same gently curved screen as Ernie and Bert. As children, we had seen a man walk on the moon. The assassination attempt on President Reagan a few years before played on constant repeat, and Tiananmen Square a couple of years later got the full info-tainment ride.īut there was something more with the Challenger. That "coverage of the coverage" was a new phenomenon but hardly restricted to the Challenger. More: Teachers who sought to fly in space look back at Challenger disaster (A thousand soap opera fans called ABC to complain about their shows being pre-empted.) The Beacon Journal's coverage that week included an article specifically about television's treatment of the disaster.
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