CEO Report: Safety in Numbers

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May 1, 2013 Volume 77, Number 5
CEO Report: Safety in Numbers Paul Pomerantz

The airline industry and anesthesiology have often been compared – and for good reason. Both disciplines have made enormous strides in safety and have nothing less than perfection as their goal. Both disciplines have engendered an almost incomprehensible level of trust in people as they undertake activities that are, by their very nature, exceedingly dangerous and risky. Yet mistakes still happen.

Author Malcolm Gladwell has made some interesting arguments about what it takes to continually improve and achieve great things, both personally and within organizations. In the book Outliers, he describes the airline industry as a primary example of an entity that has made the reduction of errors that jeopardize human safety as its top priority. In a CNN interview in 2008, Gladwell said this:

“Korean Air had more plane crashes than almost any other airline in the world for a period at the end of the 1990s. When we think of airline crashes, we think, oh, they must have had old planes. They must have had badly trained pilots. No. What they were struggling with was a cultural legacy, that Korean culture is hierarchical. You are obliged to be deferential toward your elders and superiors in a way that would be unimaginable in the U.S.”

He goes on cite how these factors led to disastrous situations and how the airline worked to overcome these cultural barriers to teamwork to become among one of the world’s safest airlines. Gladwell’s beliefs are not without controversy, but anyone who has worked in the health care industry can surely see the truth in his commentary about the effects of hierarchal thinking on teamwork and decision-making.

Two months ago, I had reason to consider how important collaboration and teamwork are during an all-staff meeting at our Park Ridge headquarters. Once a month, ASA staff assembles in our lunch room (with D.C. staff attending via video-conference) to recap important past events and to discuss future plans. In March, the staff broke up into small groups and jotted down their answers to the question: “When are you most proud to be an ASA employee?” The two most common themes mentioned were “Teamwork/Collaboration” and “Member Service.” As a CEO entering just his second month of service to ASA at that point, nothing could have sounded sweeter to me. Here are some of the staff’s specific answers:

  • “Collaborating with a team to accomplish a goal.”
  • “Working with a diverse group of staff members.”
  • “Teamwork between the departments.”
  • “When there is no single solution, but we come up with the best one by consensus.”
  • “Proud to help doctors practice better to help save lives.”

  • Those last two really summed up why we wanted to institute the small-group collaboration in the first place. Hearing the staff’s answers, it was clear to me that anesthesiology’s culture of vigilance and passion for perfection resonates through every level of the Society. It was also clear that the staff grasped the importance of working together to achieve common goals and felt comfortable speaking freely when solutions were needed for problems. This sense of unfettered collaboration is priceless to ASA’s leaders because – despite the Society’s conventional hierarchal leadership structure – we do not pretend to recognize or even understand every problem that needs addressing. Problems are solved just as often from the ground up as they are from the top down.

    I’d like to quote Malcolm Gladwell again, also from his book Outliers: “Errors… furthermore, are rarely problems of knowledge or flying skill. It’s not that the pilot has to negotiate some critical technical maneuver and fails. The kinds of errors that cause plane crashes are invariably errors of teamwork and communication. One pilot knows something important and somehow doesn’t tell the other pilot. One pilot does something wrong, and the other pilot doesn’t catch the error. A tricky situation needs to be resolved through a complex series of steps – and somehow the pilots fail to coordinate and miss one of them.”

    I agree with Mr. Gladwell. In my 35 years of experience in the health care industry, it’s apparent that errors most often happen as a result of teamwork and communications issues, and too often because of an outdated reliance on hierarchy that stifles open dialogue. I’m proud that the staff who work for you at ASA feel comfortable speaking their minds. I need their input so I can offer the best solutions to help you do your job – keeping patients safe.

    The articles in this issue of the NEWSLETTER explore the numerous ways in which anesthesiologists work to make a remarkably safe (though undeniably risky) medical specialty even safer. Teamwork, collaboration, communication and learning from mistakes are all crucial aspects of anesthesiology’s continued success.

    On behalf of every team member here at ASA, I’d like you to know that we have your back, and that each and every one of us is speaking out, on the same team, for the same goal: that no patient be harmed by anesthesia.

    Paul Pomerantz is ASA’s Chief Executive Officer.