When we discuss the feasibility of team training in health care, many medical professionals insist that the aviation safety model can never be applied to the healthcare workplace. Why? Because those who work in hospitals and other health care institutions may never have never worked together before and the time constraints of much healthcare work makes teamwork difficult if not impossible.
Well, Patrick Mendenhall and I just had an experience, which shows how well strangers can create teamwork in a short of amount of time, if they have a good team leader and have rehearsed it in other settings.
On Wednesday April 24th, Patrick and I were guests on the Leonard Lopate show, on WNYC/NPR radio talking about our book Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety . Leonard Lopate has been a radio interviewer for 28 years and Patrick and I have had a lot of experience working with teamwork. As I sat in Leonard Lopate’s New York City Studio, Patrick was patched in from Tacoma, Washington and was thus a disembodied voice coming over the airwaves. Read more >>
Jane Lipscomb is a Professor at the University of Maryland School of Nursing. She and I have worked together for a number of years on the issue of teamwork and communication in the workplace. With former professor Kate McPhaul of the School of Nursing, Jane wrote a great chapter on workplace violence and legislation used to curb it in the state of Washington for my edited collection When Chicken Soup Isn’t Enough: Stories of Nurses Standing Up for Themselves, Their Patients and Their Profession. She and Kate McPhaul also did an op-ed which appeared in the Baltimore Sun on workplace violence which is reprinted in the third edition of the book Bernice Buresh and I wrote, From Silence To Voice: What Nurses Know and Must Communicate to the Public, which was just published by Cornell University Press. Here is another op-ed that Jane wrote for the Sun on the critical issue of workplace violence. http://www.baltimoresun.com/news/opinion/oped/bs-ed-workplace-safety-20130425,0,3427531.story This article shows how those who advocate for change, whether in nursing, medicine or anywhere else can use the media creatively to advance the debate about critical issues.
The other day I flew from Oakland to Denver and back on Southwest Airlines. Southwest is a special company. To find out precisely why, it’s useful to read Jodi Hoffer Gittel’s book on the airlines entitled The Southwest Airlines Way. Here I want to reflect on how Southwest’s communications and safety culture impacts passenger interaction – how the company’s mode of interaction changes the way passengers interact.
What do I mean by this? Here’s a typical story. It began as we lined up at the by now well-known Southwest boarding markers. I was positioned at A51. As people lined up forward and aft, they began to talk to one another. First about what number they were – which meant allowing someone to scrunch in in front of or behind you with good grace. Then it involved helping some passenger – in this case an older woman who was unfamiliar with the system and seemed to have a hard time mastering the concept that she was B 50 not A 50 – navigate the procedure. Schooled by other airlines where you just all jam in, she seemed to find it hard to believe that she couldn’t just scoot in with us A’s. Politeness was the name of the game here, but so was firmness. Read more >>
I have told the story about the supposedly clean IV pump in the dirty utility room — see previous post — to a lot of people over the course of this last week. Kind of like a focus group exercise. Can you guess what most people immediately say? The usual. Blame the nurse. What kind of stupid person would think a pump that is supposedly clean is really clean if it’s in a dirty utility room? In this instance, as in so many others, the game is blame the individual, in this case the nurse. This in spite of more than two decades of research telling us that creating ambiguous situations like the one I just described is a recipe for smart and well-intentioned people to make catastrophic errors. This is particularly true when people work in high stress environments where they are over-worked and fatigued(latent pathogens if there ever were ones) as most nurses, doctors, and others who work in health care are today. Read more >>
In their book Managing the Unexpected: Assuring High Performance in an Age of Complexity, Karl E. Weick and Kathleen M. Sutcliffe outline the characteristics of a High Reliability Organization (HRO). HROs, they explain, are preoccupied with failure, reluctant to embrace simple interpretations of problems, sensitive to operations (i.e. the frontline where work takes place), committed to resilience, and always defer to expertise (even when that expertise comes from people low down on the organizational totem-pole.
HROs also “worry a lot about the temptation to normalize unexpected events” and thus respect “feelings of surprise.“ People who work in HROs are, as they describe it “mindful.” “By mindfulness we mean the combination of ongoing scrutiny of existing expectations, continuous refinement and differentiation of expectations based on newer experiences, willingness and capability to invent new expectations that make sense of unprecedented events, a more nuanced appreciation of context and ways to deal with it, and identification of new dimensions of context that improve foresight and current functioning.” HROs always pay attention to human factors, which as Kim Vicente explains in his book The Human Factor, are the “problems arising out of the relationship between people and technology, not just at the level of the individual but also at the organizational and even political level.”
As we have argued in our book Beyond the Checklist: What Else Health Care Can Learn from Aviation Safety and Teamwork, aviation shares all the characteristics of an HRO outlined above. Because of three decades of mindfulness about safety, aviation, once a very high risk industry, is now a high reliability one. The other day, my co-author Patrick Mendenhall and I were talking to two former aircraft accident investigators Douglas Dotan and Ron Schleede . Both were at work several decades ago as the aviation safety model (ASM) of Crew Resource Management (CRM) was, no pun intended, just getting off the ground. They had first hand experience of investigating some terrible airline crashes. Read more >>