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

cactus 15.9 h-bar traitor contact i maintain one 5000 state one to 5,000 cactus 1549 after a series of avoidable crashes in the 1970s and 80s commercial airlines finally got serious about passenger safety when I in turn left 87 zero cactus 1539 the airline industry developed a revolutionary new system of job training and information sharing called crew resource management pilots flight attendants and ground crews were all trained to share information and better collaborate on the job to dramatically reduce the risk of human error and radically increase the level of safety in this high-risk industry do it okay which one way would you like at Teterboro 4ws I'm sorry say again cactus she wants a while 27:18 I think he said he's going to the Hudson lives were saved due to the combination of a very experienced well-trained crew all of whom acted in a remarkable display of teamwork along with expert air traffic controllers the orderly cooperation of our cool-headed passengers and the quick and determined actions of the professional and volunteer first responders in New York City after 30 years of CRM training air travel is now the safest it's ever been in the last 30 years the airline accident rate has decreased at least tenfold how safe and reliable are other industries like health care we're saving lives also requires teamwork and communication what occured during my daughter's hospitalization in the pediatric intensive care unit was really a cascade of errors and miscommunication we harm millions of patients a year and probably kill 100,000 or so patients a year maybe more than that from medical mistakes so in many ways we kind of continue blindly down this dark hallway or dark hole that set set us up for both harm to my patient and you know it put my practice at risk she spent seven weeks in the pediatric intensive care unit with sepsis a life-threatening infection and left her permanently disabled for the remaining 19 months of her life beyond the checklist is a book that shows how the aviation safety model can be adapted to the healthcare industry her resource manager was a program that gave you a process in a language and everyone knew that everyone knew the language so if I said to you captain I'm not comfortable with this he had to hear that because it was done in a process in a way that we were all trained it just meant that if you spoke up they were gonna listen it also meant you had a responsibility to speak up first they did not buy into it I would say the majority of my colleagues in the 1980s thought this was just another fashion trend they refer to it as Charm School the old way that healthcare was organized with the doctor up here and everybody else down here really created terribly unsafe conditions they come in they see the patient they do possibly order entry and then they're off the floor before the bedside nurse even knows that they've come and gone all of the the errors and miscommunication were just catastrophic in the way they affected my daughter so what does it mean to go beyond your checklist the aviation safety movement is not one thing like a checklist you know that's why we call the book beyond the checklist because it's about leadership it's about followership it's about anticipating threats and working together to figure out what you're going to do it's about soliciting input it's about encouraging people to speak up and supporting them when they do speak up it's about teamwork training and communication training and that's what needs to be done in healthcare simple fixes like using a checklist or doing a double check those help but if you don't change the culture if you don't change the nature of people people's work how doctors and nurses communicate with each other how we train young residents and medical students then you can't real you can make some progress but you can't completely fix this problem CRM can benefit the medical industry the same way the airline industry in that lives are at stake in both industries first of all there's too many patients getting harmed and there's too many gaps in communication I can't wait for the system to change the problem is we don't have a lot of time because patients are dying every day and patient advocates I work with you know wonder where is the outrage how many more people are going to die before we're going to really change the system beyond the checklist is available at Amazon or beyond the checklist com


  1. An excellent book for all who want a real change to a better, safer and error poorer culture – not only in hospitals

  2. Wow, my husband, a pilot sent this to me. My mother died last year on July 20th, to use your words, from a cascade of errors and miscommunication, that was catastrophic. So unnecessary. I want to be my mother's advocate, her voice, I want to know how I can help to change things and get CRM integrated into the healthcare industry. I felt so helpless and could not help her.

  3. Thank you for writing this very important book.It describes a wonderful model for what healthcare could look like. It is imperative that all of us in healthcare do the hard necessary work to change the cultures that lead to mistakes and errors. We need true teamwork, team intelligence, communication, an understanding each others roles and scopes of practice, inter-professional education (and perhaps the use of partnership, dialogue and polarity thinking) to transform an unsafe culture.

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