The Southwest Way — Another Lesson from the Aviation Safety Model
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.
As we were standing in our line, most of us were watching the CNN broadcast in which multiple news casters were relentlessly keeping us up to date on the search for the two men – at that point no one quite knew who they were – thought responsible for bombing the Boston Marathon. As the young men’s blurred faces appeared on the screen, two men standing behind me were talking about what should be done with them. One of them blithely insisted that the FBI should just shoot them point blank and claim the suspect was “resisting arrest.” A few minutes later, the a reporter announced that a young college student wearing a white baseball cap had been surrounded by police who thought he was the bomber. Turned out, he was just a kid wearing a white baseball cap. I wanted to ask my fthe men if they thought the cops should have shot him – he probably would have resisted arrest since he had been guilty of only wearing a white baseball cap. But in the spirit of Southwest I decided to go for good Karma and keep my mouth shut.
When we walked down the jetway, we were greeted by the two pilots – first officer and captain – who stood outside the planes entrance to say hi. The older captain didn’t seem to be very chatty, although he smiled pleasantly. But the first officer was amiable and loquacious, greeting each of us. “Are you on your way home?” he asked me. To which I responded yes and asked him if he was too, to which he replied,” Yes, it’s always great to get back.” The whole interchange couldn’t have taken more than 30 seconds, but you felt in good hands, with people who at least knew that there were human beings in the back of the aircraft – human beings who’d entrusted their lives to the crew’s skills. When we had boarded and the purser made his safety announcement, he informed us that this was a “no smoking, no whining, and no complaining flight.” This is not unusual with Southwest, but after a few minutes I realized that it did more than make the passengers feel at ease. It turned us into a sort of quick team. How? After hearing his quip, many passengers, including me and the stranger sitting next to me, turned to one another to smile and say how much we appreciated the airline’s standard operating procedure. (SOP) We then began a conversation that lasted for the next hour. It made the flight go quicker. I am sure that we would never have begun to chat had the purser not made his joke.
Later on, when I went back to the aft galley to use the restroom, another passenger was doing some stretching exercises. The flight attendant was continuing her work without comment. Then I began doing some stretches and she quipped about the yoga class going on in the galley and said she was tempted to join in. When another one of the flight attendants joined her, they both began to wonder how many people we could recruit to do yoga in such a small space. There were no glowering looks from the flight attendants about crowding the galley and no dire warnings of federal marshalls closing down the exercise session. (I once flew on American to Paris – no pun intended – with my husband in economy and me in business. I would occasionally walk across the class divide to bring him a goody from my meal. After a couple of trips back and forth a grumpy flight attendant approached me and told me that there were six air marshalls on the aircraft and that they thought my behavior was erratic and didn’t I know I couldn’t breach economy from business. No actually I didn’t. I thought it was the other way around, you couldn’t go from economy to business not vica versa. I had visions of being knocked to the ground by a bunch of burly guys and taken off to Guantanomo for questioning).
I have always found the crews on Southwest to be genuinely friendly and sympatico. The company, which is by the way, entirely unionized, has excellent labor management relations and you feel like people actually like to work there. This rubs off on the passengers, not only in their relationship to the crew but to each other. Southwest is in a communicating, teamwork mode and you, as a passenger, feel that you are part of the team.
Why don’t health care executives and managers get that they can learn lessons from aviation companies like this? Many hospitals hire expensive consultants like the Studder Group who force employees to smile at patients and ask of them “is there anything I can do for you, I have time?” This in spite of the fact that staff workload is so intense that these queries are only pro forma and that the smiles conceal the heartache and frustration of stressed out workers who would love to really have the time to help their patients but actually don’t. Perhaps for safety’s sake and in their elusive search for customer/patient satisfaction, health care executives should look at yet another lesson of the aviation safety model and consider how at least one airline company puts it into daily practice. If you treat people well, control the latent pathogens in their work environment, and connect worker health and safety with passenger/patient safety and satisfaction, maybe you can solve problems instead of simply creating new ones.
I left work an hour late today. I was exhausted and disheartened. I think we’ve lost sight of the big picture on health care. It’s all about filling in the blanks on the next useless piece of paper that isn’t part of the medical record in addition to charting on the medical record. There is minimal communication between families and physicians. They turn to us for answers to questions that are out of scope of practice and are frustrated when we carefully explain that diagnosing and making prognoses are not what we can do. It angers me that I have so many obstacles to doing the job I went to school to do. I want to spend more time with my patients’ families. It upsets me that I can’t. But it also upsets me that so many nurses don’t seize the opportunity to facilitate communication between doctors and families. The family has a right to know exactly what is going on with their loved ones. And we can train a tech to do many of the tasks we do. We can train a tech to draw blood, insert catheters, take vital signs, do accuchecks, bathe, and myriad other tasks. What differentiates a nurse from a tech is an education that (hopefully) empowers to look ahead to what our patients are going to need a month from now; or to foresee potential complications they are at risk for and intervene before the complications happen. I’m not seeing that. And that lack of looking down the road can lead to untoward and potentially catastrophic outcomes for the person in the bed. Nursing us allowing itself to be de-skilled to such an extent that we are caring more for the protocols and losing sight of the fact the person in the bed had another life before they wound up in that bed – and that the lives of those who love them are on hold. That’s what we need to relearn. This was a timely post. Thank you.