Suzanne Gordon, author of Beyond the Checklist: What Else Can Healthcare Learn from Aviation Teamwork and Safety, recently wrote up an article entitled “…just two guys in a box” – Really?” which focuses on her frustration when healthcare physicians criticize the training take-aways from aviation without true understanding.
“As we have gone around the country discussing our book Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety, we have been struck by the number of people who insist that healthcare has little to learn from aviation because the two enterprises are entirely different. Critics suggest that healthcare is far more complex than aviation. One physician in charge of simulation at a large medical school blithely opined that really “in aviation, it’s just two guys in a box.” Another physician insisted that “…flying a 747 is really no different than flying a Cessna.” On further inquiry, we learned that he had done neither. Even many who are somewhat sympathetic to our message believe that healthcare and aviation have little in common.
This idea has likely taken root because people do not understand the complexity of the global system of aviation safety in which each individual flight is embedded. People think of an airplane flight as an individual, discrete entity: Plane takes off, plane lands. Just two guys in the box get it off the ground and back on the ground, and with remarkably few glitches – this happens day in and day out. This idea is reinforced each time we look up at the sky and see this vast expanse of blue (or gray if you live in Seattle as Patrick does) with maybe the odd airplane skimming the horizon. What the individual standing on the ground does not see are the many, many airplanes that are up in the sky at 28,000 to 60,000 feet, all of which function in the same kind of interconnected system that patients in a hospital or other complex facility depend on.”
Organizing the World’s Flights Everyday
Suzanne provides multiple examples of the difficulty of flying, before continuing that the differences in the content of learning is not what should be in question regarding such a conversation — but rather the structure of culture and training.
How can the responsible parties in any industry or organization best function to protect those who depend on their skills and professional judgment for survival? We can learn from best practices and relevant models wherever and whenever they are developed and then adapt them to different settings in which they may be useful. What is paramount is how an institution—or, in the case of CRM, an entire global industry—learned to change for the better and for the safer and how it has sustained change over time. What did the airline industry do concretely to transform workplace relationships and create a different model of workplace hierarchy and teamwork? How did it confront power and status differentials and learn to help people speak up about safety without fear of reprisal? What strategies and tactics did it utilize, what obstacles did it confront and overcome, and what values and practices did it change—and how? We also believe that, in spite of the differences between healthcare and aviation, the principles of CRM—learning to communicate more effectively, learning to lead a team and work effectively on a team, as well as learning to manage stressful workloads and anticipate a variety of threats to safety, as well as to prevent, manage or contain error—are crucial in healthcare and can and should be taught to and learned by all who care for the sick and vulnerable.
We think you’ll appreciate this argument even more if you consider the complexity of what happens up there while you are down here. Or what happens up there to get you back down here safely. Aviation, with all its system complexity managed to transform a toxic and dysfunctional culture over thirty years ago. We believe, as healthcare acknowledges its own similarities to where aviation was, those lessons can be similarly and very effectively applied. “
Read Suzanne’s full article and many more at her website http://suzannecgordon.com/