Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety is a well-written and well-researched book that makes a compelling case for a collaborative leadership and team development process called Crew Resource Management (CRM). CRM, explained by authors Suzanne Gordon, Patrick Mendenhall, and Bonnie Blair O’Connor was developed by the airline industry following a disturbing pattern of preventable and catastrophic taking place in aviation in the 70s and 80s that contributed to marked improvement in safety. The principles of the process are explained and there are many opportunities for adapting it to healthcare systems. As a specialist in group process consulting and a nurse, I can see great value in this work.
We can argue about differences between aviation and healthcare until the cows come home, but would miss the extremely helpful points this book clearly makes and supports with extensive references. Some highlights include but are not limited to:
* The importance of speaking up and listening in a hierarchal system where the stakes are high and the deadly consequences that can arise from obstacles that exist when that hierarchy is toxic.
* People in highly responsible leadership positions such as doctors, nurse managers, and pilots absolutely must be able to stay in charge while respecting all resources. This is a dance between leading and managing that requires expertise in one’s field of knowledge as well as communication and team-building.
* People in highly responsible team roles such as flight attendants, nurses, physical therapists, nurses’ assistants, housekeepers, maintenance staff must absolutely be able to follow and initiate change i.e. speak up with concerns. This requires an ability to follow and to be actively engaged in the process as a vital resource.
* Workload Management and the safety consequences of task saturation. It is a well-documented wake-up call about human limitations and stress.
* Safety as system-wide priority. Unless it is the true priority, over profit, over ego, patient safety will be an illusive goal. The book includes a fascinating section on how FAA regulation helped ensure safety and an alarming point about healthcare’s resistance to a similar approach. Something we should consider, if we want to provide safe care.
* Group process work, like CRM can be adapted to meet the needs of healthcare systems. (And my own caveat that ‘medical improv‘ holds incredible promise in this work because it builds the emotional intelligence and relationships that are necessary for team intelligence).
I highly recommend this book to colleagues in all healthcare disciplines including consumers in patient advocacy roles. It is filled with case studies, such as Maimonides Medical Center, (including their progressive and detailed ‘Code of Conduct’) and Osher Clinical Center for Complementary and Integrative Medicine, along with responsible research in aviation and healthcare that highlight successes and support the need for the work. The more people who read and cite this book, the more we can make a compelling case for addressing the human factors in creating safe healthcare. It is also an important book to get onto the mainstream bookshelves in educational programs for all healthcare professional studies.
The evidence already exists for making the changes we need to make and Beyond the Checklist brings it front and center!