A bridge-building disaster should be incomprehensible in today’s technical world. Humans have been building bridges for centuries. The science should be well sorted out by now — and for the most part, it is.
But the National Transportation Safety Board’s investigation of the March 2018 collapse of the FIU pedestrian bridge highlighted basic design flaws and a complete lack of oversight by every single party that had responsibility to either identify the design errors or stop work once it was clear that there was a massive internal failure.
We all know “what happened” here. But the “why” is more elusive. None of the responsible organizations had any intent for this tragic event to occur or to cause any injury or loss of life. Sadly, good intentions do not suffice for competence and diligence.
The highest priority now? To truly honor those who lost their lives that day, leaders must quickly implement the NTSB’s recommendations, including those issued to the Florida Department of Transportation, the American Association of State Highway and Transportation Officials and FIGG Bridge Engineers, Inc.
Engineering schools will use this as a landmark case study for years — and they should.
The engineer of record employed by FIGG was experienced, but his calculations were erroneous. Reflection on this event should go far beyond merely a technical review. The checks and balances that were required by FDOT and ASHTO were completely lacking.
Louis Berger, the peer reviewing organization, lowered its bid to review the project by 43 percent in order to get the business, but also reduced the scope of the review. The reason given was there wasn’t enough money in the project to cover their efforts. That’s both disingenuous and unconscionable. It also was in violation of FDOT’s requirement that there be an independent second set of eyes to review everything — not just what was economically convenient.
So the bridge was not properly designed and there was no qualified oversight on that design. When the inevitable began to happen — a creeping, catastrophic material failure — nobody did anything, such as closing the road, despite what NTSB Chairman Robert L. Sumwalt accurately described as the “bridge screaming at everyone that it was failing.” Why?
This whole episode reminds me of the space shuttle Challenger disaster, where the decision was made to launch in extremely cold weather that could weaken key components. Rationalization, optimism and schedule pressure contributed to what has been described in management training circles as “group-think.” Strong and confident personalities persuade everyone that everything will be OK. Despite misgivings and technical expertise that advise against such action, the team moves forward as a group.
It appears that the same mindset was in play here, in every organization: FIGG, Louis Berger, MCM (the construction company), Bolton Perez (the engineering firm overseeing the bridge construction), FDOT and finally, Florida International University. It also appears that every organization absolved themselves of responsibility by rationalizing that if the engineer-of-record says it’s OK it must be OK, and if anything bad happens — it’s on him. That is not the intent of peer review or safety oversight, and certainly fails the system of checks and balances in place to prevent catastrophes like these.
Along with group-think, another answer to “Why?” must include human complacency. It is not a term the NTSB uses often, but, in my opinion, it is present in almost every accident and crash. We are creatures of habit, and when we become comfortable through long repetitive experience, the guard often comes down — periodically with disastrous results.
This is precisely what safety management systems are designed to prevent — to trap errors in the process before they become catastrophes. While the cause of disasters may be perfectly clear in hindsight, the best organizations take proactive measures — constantly. Schedule pressure, economics, overconfidence and complacency all work to counter good intentions and too often create tragedy.
By implementing the NTSB recommendations and embracing safety management systems, officials now have the opportunity to turn tragedy into a safer bridge to the future.
Bruce Landsberg is vice chairman of the National Transportation Safety Board.