Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety

by Suzanne Gordon, Patrick Mendenhall, Bonnie Blair O'toole, Chesley "Sully" Sullenberger (Foreword by)

Overview

The U.S. healthcare system is now spending many millions of dollars to improve "patient safety" and "inter-professional practice." Nevertheless, an estimated 100,000 patients still succumb to preventable medical errors or infections every year. How can health care providers reduce the terrible financial and human toll of medical errors and injuries that harm rather than heal? Beyond the Checklist argues that lives could be saved and patient care enhanced by adapting the relevant lessons of aviation safety and teamwork. In response to a series of human-error caused crashes, the airline industry developed the system of job training and information sharing known as Crew Resource Management (CRM). Under the new industry-wide system of CRM, pilots, flight attendants, and ground crews now communicate and cooperate in ways that have greatly reduced the hazards of commercial air travel.

The coauthors of this book sought out the aviation professionals who made this transformation possible. Beyond the Checklist gives us an inside look at CRM training and shows how airline staff interaction that once suffered from the same dysfunction that too often undermines real teamwork in health care today has dramatically improved. Drawing on the experience of doctors, nurses, medical educators, and administrators, Beyond the Checklist demonstrates how CRM can be adapted, more widely and effectively, to health care delivery. The authors provide case studies of three institutions that have successfully incorporated CRM-like principles into the fabric of their clinical culture by embracing practices that promote common patient safety knowledge and skills.

The coauthors infuse this study with their own diverse experience and collaborative spirit: Patrick Mendenhall is a commercial airline pilot who teaches CRM; Suzanne Gordon is a nationally known health care journalist, training consultant, and speaker on issues related to nursing; and Bonnie Blair O'Connor is an ethnographer and medical educator who has spent more than two decades observing medical training and teamwork from the inside.

Product Details

ISBN-13:	9780801478291
Publisher:	Cornell University Press
Publication date:	12/15/2012
Series:	The Culture and Politics of Health Care Work
Edition description:	New Edition
Pages:	280
Product dimensions:	7.00(w) x 9.90(h) x 0.70(d)
Age Range:	18 Years

About the Author

Suzanne Gordon is Visiting Professor at the University of Maryland School of Nursing and was program leader of the Robert Wood Johnson–funded Nurse Manager in Action Program. She is the author of Life Support and Nursing against the Odds, coauthor of Safety in Numbers and From Silence to Voice, editor of When Chicken Soup Isn’t Enough, and coeditor of First, Do Less Harm and The Complexities of Care, all from Cornell. Patrick Mendenhall is a Principal in Crew Resource Management LLC who is a pilot for a major commercial airline and belongs to the Air Line Pilots Association. Bonnie Blair O’Connor is Professor of Pediatrics (Clinical) and Associate Director, Pediatric Residency, at Hasbro Children’s Hospital/Alpert Medical School at Brown University.

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Table of Contents

Foreword by Captain Chesley "Sully" SullenbergerIntroduction
1 History of Crew Resource Management
2 Communication
3 Case Study: Maimonides Medical Center
4 Team Building
5 Case Study: Osher Clinical Center for Complementary and Integrative Medical Therapies
6 Workload Management
7 Case Study: Interprofessional Education and Practice at the University of Toronto
8 Threat and Error Management
9 Why CRM Worked
10 The Problems in Medicine
11 ConclusionAppendix: Maimonides Medical Center Code of Mutual RespectGlossary
Notes
Index

What People are Saying About This

Sean P. Clarke

The ideas presented in this book are so clearly developed and the writing so engaging that its audience will not be limited to patient safety experts. Patients, their families, and health care providers of all kinds will also benefit from the authors' insight into hospital safety improvement. The case studies are rich in detail and full of critical reflections on the connection between quality care and optimally functioning teams. The tone of Beyond the Checklist is hopeful but, for good reason, very urgent as well.

Michael W. Leonard

Beyond the Checklist helps us understand that successfully providing safe and reliable care for our patients requires a multifaceted approach. Mechanisms such as checklists need to be integrated with effective leadership, teamwork, knowledge about human factors, and continuous learning. This book provides valuable insights on a journey that will provide a better care experience for patients, their families, and the people providing care.

Robert L. Wears

Beyond the Checklist takes us behind an apparently simple tool to lay out the complex social and organizational transformation that makes the checklist effective in aviation and to argue for a similar top-to-bottom transformation of health care. By shifting our attention to the detailed, sustained, and careful work that will be required to make health care safer, the book moves us forward on a long, difficult, but ultimately rewarding journey.

Theresa Brown

This book is a revelation! Anyone who believes that toxic hierarchies and dangerously ineffective communication are inevitable in health care should think again. Beyond the Checklist heralds a new kind of hospital workplace—one that's already been flight-tested. The dysfunctions of our health care system are tragic and unnecessary, but they can be fixed. This book shows us how.

Lucian L. Leape

This is the fascinating story of the development and implementation of Crew Resource Management (CRM) in aviation and how it can and must be employed in health care. In spite of differences between aviation and health care, the similarities are more striking. Both are intrinsically hazardous endeavors, with complex technology, and dominated by one profession. Both developed a dysfunctional hierarchical culture that substantially increases risk for its customers and patients. Aviation has done something about it: CRM, with dramatic results. Flying is now incredibly safe. The lessons are clear, the cause is urgent, and the time has come for all health care organizations to act accordingly.

Julia Hallisy

Some experts downplay the parallels between health care and aviation, but there is much we can learn from the system-wide change that greatly improved passenger safety on commercial airlines. This excellent book highlights the innovative programs of pioneering hospitals where better teamwork and effective communication guide every interaction—from the bedside to the boardroom.

Heather M. Young

This important book brings both a sense of urgency and the hope of clarity in addressing a fundamental and widespread problem in health care. It is a must-read for clinicians and students who deliver care and a call for leadership from every member of the interprofessional team. Leadership is required to change the culture and systems of care delivery. Beyond the Checklist provides the inspiration and a path for that change.

Terry R. Rogers

The deeper I progressed into this terrific book, the more embarrassed I became for my profession of medicine. Behind our casual assumption as airline customers that we will arrive safely lies an enormously complex process that addresses all human and system issues that could possibly affect safety in air travel. With a few notable exceptions, we in medicine do not come anywhere remotely close to where we need to be to assure our patients of this same kind of safety commitment. There can be no excuse for medicine not pursuing this same all-engaging, relentless process. Our patients deserve nothing less. This is a must-read book for anyone with any connection at all to the delivery of health care services.

Editorial Reviews

An excellent account of the history of crew resource management (CRM), its virtues, and how it's supposed to work, the book also delivers an eye-popping look beyond the supposedly sterile drapes in some of the United States’ most prestigious hospitals. Approximately 100,000 patients die in the U.S. every year as a result of medical mistakes, and some of the behavior that goes on in the U.S. healthcare system, as described in the book, is appalling. 'Health care needs... a radical cultural transformation, like the one that has taken place in aviation over the past 30 years,’ the authors argue persuasively. Three positive case studies show that it can be done.

Air Line Pilot - Jan W. Steenblik

An excellent account of the history of crew resource management (CRM), its virtues, and how it's supposed to work, the book also delivers an eye-popping look beyond the supposedly sterile drapes in some of the United States' most prestigious hospitals. Approximately 100,000 patients die in the U.S. every year as a result of medical mistakes, and some of the behavior that goes on in the U.S. healthcare system, as described in the book, is appalling. 'Health care needs... a radical cultural transformation, like the one that has taken place in aviation over the past 30 years, ' the authors argue persuasively. Three positive case studies show that it can be done.

--Jan W. Steenblik "Air Line Pilot"

This book is full of information from air investigations and interesting facts. The first flight attendants, for example, had to be registered nurses in case any passengers became unwell. It shows that the everyday implementation of such things as checklists is part of a commitment by an industry to change the way it works. This commitment comes through leadership, but involves all the team, and is key for a nursing audience.

--Dan Wolstenholme "Nursing Standard"

From the Publisher

"This is the fascinating story of the development and implementation of Crew Resource Management (CRM) in aviation and how it can and must be employed in health care. In spite of differences between aviation and health care, the similarities are more striking. Both are intrinsically hazardous endeavors, with complex technology, and dominated by one profession. Both developed a dysfunctional hierarchical culture that substantially increases risk for its customers and patients. Aviation has done something about it: CRM, with dramatic results. Flying is now incredibly safe. The lessons are clear, the cause is urgent, and the time has come for all health care organizations to act accordingly."

Lucian L. Leape

"This important book brings both a sense of urgency and the hope of clarity in addressing a fundamental and widespread problem in health care. It is a must-read for clinicians and students who deliver care and a call for leadership from every member of the interprofessional team. Leadership is required to change the culture and systems of care delivery. Beyond the Checklist provides the inspiration and a path for that change."

Heather M. Young

"This book is a revelation! Anyone who believes that toxic hierarchies and dangerously ineffective communication are inevitable in health care should think again. Beyond the Checklist heralds a new kind of hospital workplace—one that's already been flight-tested. The dysfunctions of our health care system are tragic and unnecessary, but they can be fixed. This book shows us how."

Theresa Brown

"The ideas presented in this book are so clearly developed and the writing so engaging that its audience will not be limited to patient safety experts. Patients, their families, and health care providers of all kinds will also benefit from the authors' insight into hospital safety improvement. The case studies are rich in detail and full of critical reflections on the connection between quality care and optimally functioning teams. The tone of Beyond the Checklist is hopeful but, for good reason, very urgent as well."

Sean P. Clarke

"The deeper I progressed into this terrific book, the more embarrassed I became for my profession of medicine. Behind our casual assumption as airline customers that we will arrive safely lies an enormously complex process that addresses all human and system issues that could possibly affect safety in air travel. With a few notable exceptions, we in medicine do not come anywhere remotely close to where we need to be to assure our patients of this same kind of safety commitment. There can be no excuse for medicine not pursuing this same all-engaging, relentless process. Our patients deserve nothing less. This is a must-read book for anyone with any connection at all to the delivery of health care services."

Terry R. Rogers

"Some experts downplay the parallels between health care and aviation, but there is much we can learn from the system-wide change that greatly improved passenger safety on commercial airlines. This excellent book highlights the innovative programs of pioneering hospitals where better teamwork and effective communication guide every interaction—from the bedside to the boardroom."

Julia Hallisy

"Beyond the Checklist takes us behind an apparently simple tool to lay out the complex social and organizational transformation that makes the checklist effective in aviation and to argue for a similar top-to-bottom transformation of health care. By shifting our attention to the detailed, sustained, and careful work that will be required to make health care safer, the book moves us forward on a long, difficult, but ultimately rewarding journey."

Robert L. Wears

"Beyond the Checklist helps us understand that successfully providing safe and reliable care for our patients requires a multifaceted approach. Mechanisms such as checklists need to be integrated with effective leadership, teamwork, knowledge about human factors, and continuous learning. This book provides valuable insights on a journey that will provide a better care experience for patients, their families, and the people providing care."

Michael W. Leonard

This book is full of information from air investigations and interesting facts. The first flight attendants, for example, had to be registered nurses in case any passengers became unwell. It shows that the everyday implementation of such things as checklists is part of a commitment by an industry to change the way it works. This commitment comes through leadership, but involves all the team, and is key for a nursing audience.

Nursing Standard - Dan Wolstenholme

Using the principles learned in the aviation industry through a program called Crew Resource Management, Gordon (When Chicken Soup Isn’t Enough: Stories of Nurses Standing Up for Themselves, Their Patients, and Their Profession) and her coauthors propose that this plan also be used for hospitals and medical staff. They write about how the airline industry has successfully cut down on disasters by using input from all personnel and getting them to work better as teams. Much time is spent explaining how the airline industry does that and how it has improved its safety records. They write about the training methods used and the airlines rules to make pilots and others comply. Unfortunately, because more than three-quarters of this book is spent on the airlines, not much is written about what suggestions would allow this plan to be implemented in medical situations. Nor do they spend much time writing about how they would propose that physicians be incorporated into the actual plan or induced to comply with the procedures.

Verdict Readers who are interested in aviation industry safety information would find this book challenging, but there is not much concrete medical safety information here.—Karen Sutherland, White Oak Lib. Dist., Romeoville, IL

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