Closing keynotes at conferences are a mixed bag. They’re typically heavy on the rah-rah inspiration and light on the actionable content that’s relevant to why the audience attended.
Still it was hard not to be excited to hear Capt. Chesley Bernett “Sully” Sullenberger III present the final remarks at HIMSS last week. Capt. Sullenberger was the face of the “Miracle on the Hudson” event in January last year. The Airbus A320 he was piloting struck a flock of birds, lost two engines and he and his crew successfully landed the aircraft in the Hudson river, saving all aboard.
From everything I’ve seen and read about Capt. Sully, he’s a very smart, articulate, accomplished individual. And that’s just what I expected to see when he took the stage.
What I didn’t expect to hear was a finely crafted assessment of the state of patient safety in the U.S. healthcare system.
Specifically, Capt. Sully talked about the use of checklists in healthcare to reduce infections and surgical outcomes. This isn’t a new idea of course. It’s been getting increased attention including Atul Gawande’s book The Checklist Manifesto published in December.
Yet adoption of checklists by the medical establishment continues to be low. Doctors feel the checklists somehow demeans their capabilities or removes their latitude in creative problem solving.
Gawande’s fundamental argument is that checklists are a simple solution and they work astoundingly well. Capt. Sully adds the human element to that argument by explaining why they work and, more importantly, that checklists empower physicians rather than holding them back.
By way of example, Capt. Sully, who has a long record of working on airline safety issues, explains that in a crisis, the pilot will routinely allow the co-pilot to fly the plane. Freed of these burdens, the pilot has the freedom to develop a strategy for how to proceed.
Pilots cannot believe checklists aren’t standard practice in medicine – “you can’t do anything that complicated without a checklist.” No one is infallible. However, by using checklists, you can at least be sure that your crises happen over the hard things, and not the easy things.
Checklists need to be combined with a few other fundamental shifts in the way healthcare teams work. First, the entire care team needs to work together in an atmosphere of professional respect. Anyone involved in the care of the patient should be able to raise a red flag and force the entire team to stop and take a look at what’s going on with the patient.
Finally, eliminating errors comes from examining the system and finding process solutions to prevent future errors. Healthcare today uses an individually punitive system. When something goes wrong, the energy is invested in finding individual fault and then punishing that individual. The result is that the people involved try to hide errors or impede their investigation. The airline industry wasn’t able to eliminate errors to the extent that it has until this aspect of the system changed.
It was easily the best closing remarks I’ve heard at a conference, and yet, we were really the wrong audience to hear it. HIMSS is a great group of IT professionals representing all aspects of the field. The people who needed to hear this presentation are the Chief Medical Officers and other physicians. I certainly hope Capt. Sully’s speaking career continues strongly and that he gets the opportunity to present this topic to lots of docs in the future.