Abstract
The first and most important step in solving any problem is understanding the problem well enough to create effective solutions. To this end, several software-related spacecraft accidents were studied to determine common systemic factors. Although the details in each accident were different, very similar factors related to flaws in the safety culture, the management and organization, and technical deficiencies were identified. These factors include complacency and discounting of software risk, diffusion of responsibility and authority, limited communication channels and poor information flow, inadequate system and software engineering (poor or missing specifications, unnecessary complexity and software functionality, software reuse without appropriate safety analysis, violation of basic safety engineering practices in the digital components), inadequate review activities, ineffective system safety engineering, flawed test and simulation environments, and inadequate human factors engineering. Each of these factors is discussed along with some recommendations on how to eliminate them in future projects.
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