I flew home the other day in a small commuter jet, after a long day of meetings in Regina. I love this flight: 35 minutes of flying over our patchwork prairie. I was seated in the front row aisle seat, so instead of looking out the window, I had the the opportunity to watch the pilot and copilot fly us home. You don’t often get to do this anymore. Commercial airline pilots used to invite you in to the cockpit all the time, to watch and learn. But the additional security measures instituted after 9/11 have pretty much stopped this practice.
I had a clear line of sight and this is what I saw: teamwork, vigilance, and a commitment to executing a well thought-out plan. Working as a team, the pilot and copilot shared the responsibilities and tasks. They worked together so closely that at one point it looked like both pilots had their hands on the throttle as we accelerated down the runway.
We love to make comparisons between healthcare and aviation. But from where I sit, healthcare has a long way to go before we can say that we are “just like” the aviation industry when it comes to safety and teamwork. Many in healthcare protest when the idea of “standard work” in medicine is even raised. Physicians fear that our autonomy is threatened when we are asked to manage medical problems or provide care using a clinical pathway — even when we, the doctors, are given the opportunity to create the pathway for our patients.
Dr. Philip Fourie, family physician and past president of the Saskatchewan Medical Association, told me a story that helps him understand and explain to physicians why we need to be more thoughtful about professional autonomy. At the Canadian Conference on Physician Leadership , Dr. Fourie had the opportunity to hear Jeff Skiles speak on the importance of professionalism in healthcare. Skiles was copilot on US Airways Flight 1549, the plane that was masterfully landed in the Hudson River after developing a complete engine failure minutes after take off.
He described how the airline industry used to tolerate pilot autonomy: “I’ll do the preflight check the way I choose to. I’ll lower the landing gear when I judge it necessary. I’m an expert. Your checks and processes lessen me as a professional.”
But planes would fall from the sky, lowering the landing gear would be forgotten, and pilots — along with their passengers — would die. As Dr Fourie said to me, “As a passenger, I would not get on a plane flown by a pilot who held onto these beliefs. Why do we tolerate this in healthcare?”
Does anyone think less of pilots because they, as a profession, came together with their industry partners, to set standards and processes to improve the safety of flying? We need to adopt the same behaviours and practices in healthcare.
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