Lesson learning at NASA – more details
NASA has a well-developed Lesson Learning system – here are more details.
|Image from Wikimedia commons|
I blogged recently about lesson learning at NASA, based on a report from a few years ago, and observing that the NASA LLIS system seemed to be a passive database where lessons were left until someone came looking.
As a result of this post I was invited to join a NASA webinar on lesson learning, which you can review here, and which provides a more up to date overview of the NASA approach to lesson learning. Here are my take-aways (and thank you Barbara for opportunity to attend).
Each NASA project is required to conduct lessons capture meetings, which they call “Pause and Learn”. These Pause and Learn meetings generally use an external facilitator. Lessons are entered into LLIS in a standard template, which contains the following sections:
- Driving Event
- Lesson(s) Learned
- Recommendation(s) (there is some variation in the way that Recommendations are differentiated from Lessons)
- Evidence of Recurrence Control Effectiveness
Although LLIS is essentially a passive database, there is an external process to control the re-occurrence of lessons, and many lessons seem to be referenced or referred to in standards and guidance. However even when the lesson has been referenced in standards it still remains in the database, and LLIS contains lessons all the way back to the Apollo program. I submitted a question to the webinar about how NASA deals with the archival of embedded, obsolete or duplicate lessons, but this was not one of the questions selected for discussion.
Some parts of NASA take the lesson management process further. Dr Jennifer Stevens, the Chief Knowledge integrator of the Marshall Space Flight Center, described the work of the distilling team, who look through the database of lessons and distill out the common factors and underlying issues which need correction. They see lessons as an immediate feedback system from operations, and they compartmentalise and group lessons until they can identify a corrective action; often updating a policy or guidance document as a result. Some lessons, which they can’t act on immediately, go into what they call a Stewpot, where they look for trends over time. A lesson, or type of lesson, which is seen many times is indicative of some sort of systemic or cultural issue which may merit action.
Projects are NASA are required to create a Knowledge Management plan, which they refer to as a Lesson Learning Plan, as described by Barbara Fillip, KM lead at Goddard Space Flight Center. This plan documents:
- How the project intends to learn from others
- How the project intends to learn through its lifecycle
- How the project will share lessons with others.
A few more snippets I picked up:
NASA, in their Pause and learn sessions, use “We” language rather than “They” language. The conversation is all about what WE did, and what WE should do, rather than what THEY did and how THEY need to fix it.
A motto they use to promote Learning before doing is “Get smart before you start”.
NASA do not refer to success and failure in their Lesson Learning system – they talk about Events. An Event is what happened – a Mistake or Failure or Success is just a label we put onto events. NASA seeks to learn from all events.
In conclusion, the NASA lesson learning system is as well-developed Level 2 system, and lessons are used to systematically drive change. Although LLIS does not have seem to have the functionality to automate this driving of change, there are enough resources, such as the Distillation team, to be able to do this manually.
Tags: case study, lessons learned