See Also Charles Perrow...

No Downlink: A Dramatic Narrative About the Challenger Accident and Our Time - Claus Jensen

Read in conjunction with Truth, Lies, and O-Rings: Inside the Space Shuttle Challenger Disaster

The author, a huge fan of Richard Feynman, draws on Feynman's work to discuss the problems and events leading up to the Challenger accident. I remember being at we work when one of the other deans popped in to report the explosion. This was still when Shuttle launches were watched with great interest by the public and the presence of Christa Maculiife added especial interest. Her kids were watching in school. Just imagine...

The Rogers Commission was the result, and Feynman's famous demonstration with ice water and the O-rings made everyone's favorite list of stories. Reagan in his memoirs dismisses the accident in two sentences. We had a problem, identified it, and got on with things. The author explains the systemic flaws in this book that cannot be dismissed so easily.

NASA was symbolic of large systems that surround us today, all very complex, that often devolve into uncontrollable entities where individuals eschew responsibility and suffer from bitter internal politics. Jensen examines the role of management theories in the structure of these large scale systems and the rise of HR (now, as we all know, totally out of control.) He cites Weber’s book on management (it’s impossible to have a large system without a bureaucracy) and discusses the set of principles Weber regarded as key. Note that one of them communication, and how to sort out what’s important from the river of data, was to play a part in the Challenger disaster.

Jensen does a very nice job of the examining management change during the early 60's you have a cyst was on teamwork working together I'm not punishing people for failure and the way management changed over the years before the Challenger accident is instructive He draws heavily in this section on a book I think everyone should read: Normal Accidents. The substantial disadvantages of tightly coupled systems resulted in several problems for NASA and the Apollo and Gemini programs.

Another interesting facet of the book is his examination of the relationship between the industrial/military complex (as defined by Eisenhower) and how NASA was taken over by the military once the lustre of space exploration had waned. The defense department and contractors had so intertwined contracts with thousands of communities and businesses, that it became increasingly difficult for Congressmen to vote against military (and by extension NASA since the military was now often dictating NASA specs) expenditures. 

Soon, as military companies merged large monoliths were created who, thanks to cost-plus contracts, could charge whatever they wanted. We had created a society of state capitalism. But it wasn’t just corporations who fed at government's teat. Universities fought to get grants at the expense of academic freedom. Soon an astonishing 88% of CalTech’s budget was from the government; 66% of MIT’s and even 25% of Harvard’s.

Even as the military denigrated the civilian NASA’s efforts, they were attempting behind the scenes to gain control over the program and the budget. Edward Teller was pushing Star Wars to a technologically ignorant president who loved the fantastical concept. (Never mind that cost estimates approached one trillion dollars -- the balance wouldn’t come due until he was out of office.) NASA meanwhile, had been taken over by true believers ever mindful of the need to keep the budget money flowing. Shuttles were often cobbled together from cannibalized parts from other shuttles to keep to the schedule. (The Air Force had estimated. there was a 1 in 35 chance of a disaster, making the program the most dangerous technological initiative ever.) NASA was not above telling its own version of everything. “Of all the organizations that I have dealt with … I have only seen one that lied. It was NASA. From the top to the bottom they lie … The reason they lie, of course, is because they arc wrapped up in a higher calling. In their eyes they arc white lies. They tell lies in order to do what has to be done. Because in the end the result will be for the betterment of the public. So they arc not lying from evil. But. nevertheless, they are lying.”
Can you imagine starting from scratch and putting a man on the moon in today’s contentious environment? We’d never make it to Boise.

And to follow up on that achievement, the shuttle was developed under extraordinary conditions. “Never before had a new spacecraft carried human beings on its maiden trip. And never, ever before had anyone tried to bring a spacecraft the size of a DC-9 back down through the earth’s atmosphere. Never before had there been rocket engines as powerful as those which would be required here; never before had a rocket engine filled with highly combustible liquid oxygen and hydrogen been ignited on the ground, while positioned right alongside an enormous fuel tank. And never before had it been necessary for a rocket engine to be reused, or to have a total combustion time of over seven hours. All previous rocket engines bad done well if they lasted a modest number of minutes before petering out.” 

And then they wanted to put non-test-pilots on the thing. The idea that an ordinary citizen could travel along was strongly resisted by the astronauts who understood the risks, but management wanted to show the public that space travel could be safe as commercial air travel. But no flight went without some difficulty. In one case a supplier had left out two pins from a spacesuit. Metal shavings were found blocking an oxygen release vent. Fortunately, the mission had to be cut short for other reasons. Had they tried to use the spacesuit it could have exploded, possibly smashing a hole in the orbiter. Problems with brakes were endemic. And the tiles (later linked to the Columbia disaster) were a constant problem.

The problems with the Columbia in the mission preceding that of the Challenger laid the foundation for its explosion. Delayed seven times, it was supposed to carry a Congressmen (who claimed God was instrumental in his going) into space. Each delay meant the countdown (some 2,000 pages) had to be restarted. Then there was a weather delay in getting the Columbia back, a problem because they needed parts off it for the Challenger. So the pressure to launch was immense. And we know the result.

Less a history of just the Challenger disaster, Jensen writes of the history of rocket development in the first section at some length, a distance some readers who prefer focus on the Challenger accident may not wish to travel. I thought it was excellent and provided a good background for some of the technical detail down the road. An excellent book.