In my recent post, I cited a nurse who argued against the use of the aviation safety model in healthcare. She insisted that “overpaid” aviators, as she dubbed Captain Chesley “Sully” Sullenberger and other pilots promoting healthcare safety, should all go back to the cockpit. I know Captain Sullenberger can stand up for himself. But I want to offer my defense for aviators who are trying to help doctors and nurses and other health professionals learn more about human factors and safety from an industry with a lot of similarities to healthcare. One of the main being the kind of toxic hierarchies that keep people from speaking up to those in positions of greater power.
This admonition to get thee back to the flight deck –directed at Sullenberger, and by extension the co-author of Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety – pilot Patrick Mendenhall,is as misguided as it is inaccurate. First of all, many of the pilots trying to take the lessons of aviation safety to healthcare have never left the cockpit so they don’t have to go back to it. Patrick is still flying passengers hither and yon on commercial airline flights. Captain Sullenberger, before his retirement, had over three decades in the cockpit.
Second and most important, all of these pilots who are advocating for patients themselves have a perfect right to do so. They themselves have been patients or are potential patients and so are their wives, husbands, partners, significant others, children and families and friends. They know they will be using the healthcare system like we all do and are rightfully worried about their next flight. Everyone is talking about the need to have savvy healthcare consumers who advocate for themselves. Does that exclude pilots? Ones with considerable safety training and leadership trying to share their hard won lessons with others? Not all pilots welcomed this movement when it was first launched in the 1980′s. The fact that they are now helping to address the resistance of doctors and nurses and others to the same lessons is testament to the success of the safety movement in aviation.
Leaders in healthcare aren’t going to solve the serious and well-documented safety problem in healthcare if they circle the wagons and rejected the advice and insight of people who have been quite successful at learning real teamwork skills that are mobilized everyday — not just by landing a plane in the Hudson. To adapt this defensive and counterproductive posture could well deprive doctors, nurses and other health professionals — not to mention patients — who are hungry for information and ideas which they can apply to the workplace circumstances they know and understand best. CRM, as advocated by people like Sullenberger and my co-author Patrick Mendenhall, is not a cookie cutter solution and never should be presented as such in healthcare or anywhere else. In fact, one of the reasons we called our book Beyond the Checklist (and I think one of the reasons Captain Sullenberger agreed to write its foreword) is that we agree that a complex systemof training cannot be reduced to just one part of the package, i.e. checklists.
Given the seemingly intractable patient safety crisis, we cannot afford to thumb our nose at complex methods that have been used and tested and that, of course, need to be carefully adapted and intelligently integrated into the world of healthcare work. To ignore these lessons is to condemn patients to more preventable deaths and injuries and subject those who work in healthcare to further anguish at their inability to “first do no harm.”