Fly the friendly skies of healthcare
By Shelley Burns
Captain Chesley Sullenberger’s recent address to the HIMSS conference in New Orleans forcefully reminded me of a newspaper article I read over 15 years ago.
At the time, I was a junior member of a task force working to develop and implement “Total Quality Management” at our medical center. We wanted to steal ideas from other industries to help our physicians, nurses, managers, and staff develop and implement best practices to improve quality of care, safety, cost, etc.We had been talking about benchmarking with other industries to glean “best practices” from Walt Disney for customer service. We also looked to manufacturing for zero defect best practices.
I was excited as I read the newspaper article – it was a retired commercial pilot who was doing seminars on how healthcare could take lessons from the aviation industry. The article described the paradigm shift that the aviation industry went through regarding safety. The “old” culture involved having the pilot as commander of the ship who needed no help from the first officer or the flight attendants. His (and it was always a “he”) word was law, and woe be to anyone who questioned his decisions. However, aircraft became too complicated for one man to fly. More people traveled by plane and on planes, and so a single crash cost many lives and was a public relations nightmare.Out of necessity, the industry re-framed its safety culture. It adopted a “slavish” devotion to checklists to ensure the equipment and the staff were prepared to fly (and land!). Also, there was the shift from a one-man show to a team assignment methodology. As a result, airline crashes decreased dramatically and flying became one of the safest modes of transportation in the United States. Wow – what a great industry to take some lessons from! These practices had a direct result on safety AND could be readily applied to healthcare activities!
The reporter also interviewed several local physicians and nurses about the pilot’s premise. Their reactions were disappointing. Not a single healthcare person this reporter interviewed had anything positive to say about the idea that checklists and teamwork could be used in healthcare. One nurse in particular had a dismissive opinion. “I really don’t see what this has to do with patient care”, she said. “A cockpit can’t be compared to an operating room where we are saving lives.” Unfortunately, these sentiments were echoed at my hospital when I discussed the possibility of translating some of the aviation experience to our departments and processes.
Granted, this was 15 years ago, and thankfully opinions are changing. But I still hear those dismissive voices – “We don’t need a surgery checklist. Nothing bad has happened here.” Or: “You can’t compare hospitals to aviation; they are completely different.” And there is: “No two patients are alike.We can’t have standard order sets or care paths.” Healthcare must take lessons from aviation and other industries that have transformed themselves. Hospitals CAN change and embrace a safety culture. Hospitals CAN strive for zero defects. All players have to stop thinking they can’t learn from someone else because healthcare is “too different.” Everyone must summon the will to create change in the positive direction.
Shelley Burns is director of knowledge management at HMC.
