Until the recent crash in Kentucky, US airlines had not had a fatal accident since 2001. 50 million miles flown with no loss of life. How has that come to be? What, you ask, does this have to do with physician practices?
In the movement to improve the quality of care and outcomes in healthcare, it’s been suggested that we don’t have a real feel for how things go wrong. The comparison has been made to the commercial airline industry, which has a system for reporting incidents that effect safety, and there is limited immunity from the FAA for those reporting. Stripped of names, the reports are entered into a database. The Aviation Safety Reporting System database is open for anyone to use, and gives the industry an invaluable tool to be alerted to problems, spot trends and to develop corrective action.
A report from ABC News highlights a growing body of research that suggests that the change in the culture of the cockpit has made the biggest impact in the long safety record. Beginning in the 1980s, the push for change has come from within the industry, in the routine training and evaluations of all crew members, that everyone has the responsibility to speak up if there is a safety issue that demands attention. The Tenerife disaster, where two 747s collided on the ground in fog, resulted from the KLM captain starting the takeoff roll without clearance and over the objections of the first officer. Physicians, like airline captains, are in charge of their “ship.” The traditional concept has been that the physician is the “captain of the healthcare team,” as only physicians have the responsibility and authority to prescribe a wide range of tests and treatments for patients. Today, of course, caring for patients can involve 5, 10 or more people from different specialties – physicial therapists, occupational therapists, pharmacists, an assortment of physician specialists, and so on. This makes for more complex decision making, it stresses and strains the abiity of physicians to make knowledgeable decisions, and communication can be problematic.
This particular PIC (pilot in charge) set a tone several days earlier in the trip that made challenging his decisions more difficult. His response to an appropriate query from a crew member was arrogant and left little doubt that he believed himself to be infallible. His disinterest in the ideas of others is typical behavior for this individual and is a recognized prob. Company management, however, seems to be unable or unwilling to correct his attitude. In the future, I will approach my dealings with his person with a harder and more determined edge. My challenges will either be properly addressed or I will continue to pursue the matter. But they will not, however, be brushed aside. A good lesson in CRM, all in all.
When we see things that are not right, we need to speak up, and we need to be in an environment where speaking up is safe and welcome. Within your practice, your staff can “watch your back”. They see a lot of things you don’t see, and staff have their own relationships with many patients. Start asking your staff – informally – for ideas and what they see. At first, most may be reticent so speak up. But they will come see that you are serious about asking and listening, and will speak up. For your part, look to implement some of their ideas so help demonstrate that you are serious.
A number of years ago, I worked for Dan Kane, then the CEO of Montefiore Hospital in Pittsburgh. When he came on board, the first thing he did was to hold open meetings with all staff, and he did them on all shifts (inlcuding 2AM). There were pages of notes of ideas. We set out to implement some, discard some, and work on others. Kane also reported back to employees from time to time what was happening. The transformation in the staff was palpable – people were excited about working at Montefiore, and they had tangible proof that this was a CEO and management group who were going to make a difference.
So go out and make a difference.