– USNI Proceedings – To chart a course going forward, it is necessary that we understand what went before and how it all went wrong so we can avoid the mistakes that have led us to this place. It is not enough to remedy issues such as the lack of quality sleep available to those who serve in ships, or elapsed and waived certifications, or faulty training in seamanship and navigation. It is not enough to decide that we need to begin transmitting on the automatic identification systems (AIS), or that we should rationalize all of the bridge radars and ship control systems in the fleet, or that we should usurp a captain’s prerogative to write his or her own standing orders. This approach is tantamount to treating the symptoms of an illness instead of addressing the underlying causes. The surface warfare community must determine the answer to the following question: What is the malady that lies behind the symptoms?