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by kube-system
740 days ago
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In aviation safety investigations, all contributing factors are considered, and there are usually multiple factors involved in any incident. My purpose of quoting that wasn't to be a wholly inclusive description of the situation (that's what the full report is for), it was to refute the above idea that engine defect was not the root cause. > So calling this a design issue rather than an inspection issue is quite reasonable. Inspections are guaranteed to eventually fail, the aircraft being 100% dependent on them is a recipe for future disasters. Likewise, we don't just require "good designs" instead of inspections, because even a "good design" will experience failures. In the swiss-cheese model of safety, all of the slices are important. In this case, the inspection was the first failed slice. |
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You misunderstand what a root cause is. An accident has multiple root causes in the swiss cheese model.
Each process update is supposed to address a root cause.
This is separate from contributing factors. IE: It happened at night.