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This post is the second part of the airport chaos.

The inquiry terms explained.

The terms are listed over 5 bullet points requiring some clarifications from a Service Management perspective :

1. Root cause of the incident:

Basically getting down to the bottom of what happened and in particular determining the context which created the conditions leading eventually to the service interruption.  A good analogy would be the analysis performed by firefighters after a blaze. Let’s say that, several people were killed by the smoke (cause of the death), however the root cause of the fire could have been a short-circuit in a multi-socket adaptor due for example, by a human error (too many high-hungry appliances being plugged on the same socket).

Special attention will need to be given to recent changes (change management including change control) which may have occurred over the last circa 30 days prior to the incident.

This process is often called ‘Post Mortem’, I understand that in this type of industry, the term wasn’t used.

2. Incident management:

The CAA will need to look at how the incident was handled. From an IT management perspective, it should cover Incident occurrence, System monitoring (Incident detection & Incident reporting), Service stable, service All Clear, and finally Incident communication throughout service restoration. It should also cover whether any of the different phases could have been handled quicker.

3. Problem management (Part 1) i.e lessons learned from the previous incident (December 2013) and in particular whether all the action items listed as part of the previous incident analysis were properly closed and whether any of the root cause(s) of the 2013 incident played any role in the 2014 one.

4. Business continuity plan & capacity planning: “A review of the levels of resilience and service that should be expected across the air traffic network taking into account relevant international benchmarks”.

This is interesting given the communication made by NATS that the “back-up plans and procedures worked on Friday exactly as they were designed to”. 

5. Problem management (Part 2) “Further measures to avoid technology or process failures in this critical national infrastructure”:

Basically putting together a plan to resolve (as opposed to mitigate) all underlying causes and root causes which led to the chaos. Note that this plan will be reviewed during the next incident investigation (see Problem Management part 1).

In addition to completing the problem management, NATS have requested that CAA put together a plan addressing the new requirements listed in the upcoming Business Continuity plan “Further measures to reduce the impact of any unavoidable disruption”.

In this case, they will be considering not only the actions required to prevent a similar incident from occurring again but also the actions required to address the other risks they will identify during the root cause analysis. Furthermore, they will put together a plan to increase the resiliency and business continuity (see capacity management) during major outages, considering Recovering Point Objective.

The CAA is expecting to publish the report by the 29 March 2015.