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Written by: Darlene D'Altorio-Jones (1959-2015) on Saturday, January 7, 2012 Posted in: Inpatient Rehab

At the recent Medware Annual Conference, focused on embracing change management in tough healthcare times,  I was privileged to hear a perhaps unexpected guest speaker named Capt. Steve Harden, Lifewing Partners, LLC., who presented, “Who’s Flying the Plane? Improve Patient Care by Learning From Capt. Sully and the Miracle on the Hudson.” His analogies were awe inspiring as he spoke of the similarities and disparities of high consequence outcomes for flight transportation in comparison to healthcare; two large service oriented fields of training where pilots and clinicians are hugely similar in their need to demand leadership excellence to “create expert teams from a group of experts to create everyday miracles.”

Healthcare and flight, with an adverse event, create a magnitude of difficulty that can result in horrible outcomes for those that depend on the expertise and steadfast commitment to the professions they practice.  There is no room for error, yet we see practice each day in healthcare that has a long stretch to meet the unconditional steadfast mindset of a pilot and quality outcomes. Capt. Harden quoted  James Conway, Institute for Healthcare Improvement (IHI) “Our systems are too complex to expect merely extraordinary people to perform perfectly 100% of the time. We, as leaders, have a responsibility to put into place systems to support safe practice.”  Those systems are often checklists or critical need to know data points. Points that leaders cannot take as happenstance and must assure that process, sequence and protocol are followed to enable the best possible outcomes even when contingency plans must be defaulted to.

The outcomes and successful results achieved by Capt. Sully were successful because of stringent, matter-of-fact training and strict adherence to process, sequence and protocol. He was trained and practiced every day in those three areas and was a leader to his highly skilled team. He faced a worst-case scenario and relied on specific contingency plans to calmly guide a positive outcome. It was immediate information processed just as immediately to protect from harm.

Perhaps you are not in a leadership position that makes life and death calls each day in healthcare, yet in total, all decisions you make guide highly skilled team members to service patient needs day in and day out.  Patients demand results that are driven by expectations toward specific outcomes.  Yes, clinical jobs are similar to a pilots, even minor mishaps can lead to poor outcomes. When Capt. Sully performed his job, he personally rechecked the plane before departing and then debriefed his crew to be certain that the protocol followed was measurably successful. He wasn’t thinking he would be a hero; he performed expertly what he was trained to do to avoid variance and mishap.

Capt. Harden stated we can expect that 3-5 percent of leadership will resist and will purposefully avoid a regimented approach even though they see those behaviors as holding consequences and risk.  This is the largest takeaway for me following his lecture that day.  He said “normalization of deviance, allowing the unexpected to occur is NOT ALLOWABLE.”   No harm, no foul leadership is nonsense and poses RISK; leadership of that nature produces fouls.  ”Systems are perfectly designed to get the results they produce,” a saying first coined by Dr. Paul Batalden,  Director of The Center for Leadership and Improvement, The Dartmouth Institute for Health Policy and Clinical Practice.  These two concepts say it all for the future of healthcare resistant to change but forced to accept and do so to lead highest standards of performance.

Leaders are held responsible in getting the right tools and processing the right sequence and protocols so that variance in expectations are minimum.  Expert clinical staff need real-time information and collaborative communication to make last minute choices. Allowing persons to act in a way that does not support the best outcome is allowing normalization of deviance to occur. Would you want to be a patient under that kind of leadership? It’s time to enact continuous quality improvement and design systems that provide enough data to guide real-time expected outcomes and appropriate instantaneous reactions when the unexpected occurs.  Patients depend on your leadership, leaders must disallow the unexpected.

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