Getting buy-in for a patient safety or quality improvement initiative isn't a political skill—it's a leadership skill. Here's the framework that I've seen work inside healthcare organizations. In aviation, there's a concept we take seriously: a perfectly sound tactical plan briefed poorly is a plan with a high probability of failure. The mission brief must build understanding, confidence, and alignment, or the mission objective is not likely to be met even before the wheels l

Healthcare doesn't lack for protocols, checklists, or credentialing standards. What it sometimes lacks is structured support for how clinicians actually decide, communicate, and recover from error under pressure — and that gap can cost lives. Two high-stakes industries with one shared problem. In aviation, we spent decades learning that checklists, procedures, and technical proficiency alone could not prevent catastrophic failure. The missing ingredient was always human. I sp

People often ask me what I teach in healthcare. I know they are often expecting a description of how someone who is not a clinician came to be teaching about high-reliability performance to physicians, staff, and administrators. Once they understand the pathway that led me to do what I do, they get very curious about the specific techniques, skills, and processes I provide to clinicians, and how I learned to teach those things in a way that clinicians find meaningful and use

Lancair 4 Propjet in Flight When I'm behind the controls of a carbon fiber experimental airplane powered by a 750 shaft horsepower turboprop engine, I don’t always have the luxury of perfect information when making split-second decisions. Despite my best efforts at preflight planning, I'm sometimes making decisions in environments that are complex, uncertain, and constantly changing. This is not only true for me when flying a high performance airplane, it's also true for anyo

What’s the first thing a high-stakes team does before action? They conduct a team briefing. Getting ready to start my crew briefing on an MD-11 As a fighter pilot, I never took off without a mission brief. As an airline pilot, my briefings were different, but again, I never got airborne without conducting a crew briefing. As a private pilot, even if flying solo, I prepare a flight briefing, often with the aid of online flight planning resources. The OR, ER, ICU, and labor flo

The procedure is over. The meeting ends. The shift change happens. People pack up, walk out, maybe share a few quick comments on the way to the elevator—and that’s it. But that moment is the real opportunity for learning what will improve performance for next time. When that opportunity is used, it’s called the debrief—and in too many industries where the consequences for poor performance can include injury and death, the debrief is rushed, informal, or skipped entirely. In m

Most of us will never clear a room full of enemy combatants with a rifle. But that doesn’t mean we can’t learn from those who do.

In the ICU, ER, and surgical suite, the requirement to flawlessly perform on demand while under pressure is every bit as high as it is in a fighter jet or airline cockpit or when employing firearms during a mission for the military or law enforcement . Principles, Tactics & Techniques Drive High Performance Under Pressure When seconds count and the pressure of the moment can be performance crushing, the tactics (e.g., standard procedures or protocols) are critical to accompl

Whether it's in the cockpit of a modern commercial airliner or a Navy fighter jet, great decision-making can mean the difference between mission success and failure. In these unforgiving professions, where the cost of failure can be catastrophic, effective teamwork and communication aren't just important— they're critical to achieving the desired outcome. Great decision-makers in the cockpit of an MD-11. What can healthcare leaders learn from them? As healthcare leaders navig

Let's see how a well-known surgeon answers that question. This Boston surgeon performed the wrong procedure on the hand of an elderly woman and then disclosed the excruciating details of his error in one of the nation's most prominent medical journals. As usual, this case had all of the classic error-inducing factors: The procedure was done at the end of a long day; Stress was high because several other surgeons were behind schedule. When surgeons are stressed, the surgical t

In military and commercial aviation and elite firearms training, stress inoculation is a fundamental component used to prepare...

A study of the effectiveness of debriefing revealed that in 44 months of use, the debriefing process identified 6202 defects in processes of care (e.g., issues with instrumentation, radiology, laboratory, supply, communication/safety, etc.). Wouldn't it be awesome if you had a system in your hospital or clinic to identify and fix this number of defects? Think how much better you'd be with 6000 fewer process defects! This study, among several others, showed that debriefings ar

Eliminate distractions We used to hear the flight attendant command passengers to turn off their cell phones once the cabin door was...

Years ago, when the commercial airline industry was first beginning to implement Crew Resource Management (CRM or “TeamSTEPPS” as it is...

Last week in my blog about quality improvement entitled, “Make Sounds Come Out of Their Mouths” I made what I thought was a very simple...

Recent research has revealed a simple, but totally effective tool for getting your staff to speak up every single time they perceive a...

...If not, the Time Out won't eradicate harm According to a report in the Archives of Surgery, patients undergoing surgery still risk...

Skip these important leadership steps and your new improvement project becomes a three-legged race you can’t win. (Read to the end for...

In this pandemic crisis leaders are not only at war with the COVID-19 virus, they are also at war with the debilitating effects of "battle fatigue" among their healthcare heroes on the front lines. Reports from virus hotspots around the globe reveal that clinicians are dying not only because of infection but also because of cardiac arrest or other ailments due to overwork and fatigue. Fatigue must be carefully managed or the virus war may be won at an unacceptably high cost t

Use this checklist to beat the 70% failure rate of change initiatives. Without a tool like this, your odds of success are slim.