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.
As healthcare leaders navigate increasingly complex and ever-changing environments, they can learn powerful lessons from examining how professional pilots operate and thoughtfully adapting the tactics they use to achieve peak performance. Here a just a few lessons healthcare leaders can learn from professional pilots.
Team Problem Solving Helps Make More Effective Decisions
Pilots categorize every decision they make by two characteristics – how much time is available to make the decision and the criticality of the decision – the severity of the consequences for choosing wrongly between the options.
In the lower right quadrant, leaders have the option to defer to gather more information as the criticality of any decision they make is on the lower range, and there is plenty of time to extensively consider all the factors before making a decision.
In the lower left quadrant, criticality has increased but is still in the lower range. And the time for decision-making has decreased.
Decisions made here are typically Rule-Based… following an “If this, then that” format. For a healthcare example, if a provider were to get two blood pressure readings from a patient that were in the severe range within 15 minutes, the decision is rule-based: initiate a hypertension pathway.
Following that example, if the patient’s blood pressure continues to rise and she becomes non-responsive, we'd be in the upper left quadrant. Criticality has increased, and the time to make a decision about what to do next is short.
When pilots find themselves in this quadrant, their decisions here are often Protocol-Based, such as following the Engine Fire - Severe Damage quick reference checklist for an inflight engine fire. In healthcare, decision-making in this quadrant is likewise driven by protocols, such as when the use of a Rapid Response Team is initiated (as you might do for a hypertensive, non-responsive patient).
Pilots practice their decisions and actions in this quadrant through the use of emergency drills because the criticality is so high and the time so short.
Many of the decisions leaders must make occur in the upper right quadrant. Criticality is high and to make the most effective decisions, pilots use a Team Decision Making protocol. The Team Decision Making algorithm is easily remembered by the mnemonic device “Say 3, Ask 2, Say 3.”
You begin the protocol by saying, “We must decide…” Pilots use this phrase to frame the decision, clearly stating what, exactly, must be decided. This keeps the ensuing discussion on track and out of "rabbit trails."
Next, you ask, “What do you think?” before offering your input. To avoid hearing only the loudest voices, a good practice is to ask, by name, what the most junior or inexperienced team members think to start off the discussion.
Finally, from the discussion you’ve heard, a leader must recap the options. For a healthcare leader dealing with a hypertensive patient, this might sound like, “Option 1 is to take another blood pressure reading; Option 2 is to get another cuff, in the event the one we’re using is faulty; Option 3 is to start the pathway based on the severe reading and the other symptoms.”
Now, you Ask 2 Questions.
The first is “What do you recommend?” And the second is “Why.” It’s best to combine these into one question: “What do you recommend and why?”
A good practice is to ask this of the most junior, newest, or least experienced member of the team first. Asking this question before you announce your decision helps a leader avoid "poisoning the well" and influencing the inputs they receive.
Once leaders have heard the recommendations, they complete the algorithm by Saying 3 Things.
The first is to clearly announce your decision. Do not assume the team knows the decision from the discussion. For a healthcare leader, this might sound like, “Let’s start the hypertension pathway now.”
Next, a leader briefs the game plan needed to execute the decision by answering the question, “Who must do What by When.” This might sound like, “I’ll put the order in. Beth, you obtain and administer the meds. And Jess, you continue to monitor the blood pressure and let me know immediately if anything changes”.
Finally, leaders make a "Safety Statement," which might sound like, “If you have questions or concerns, I expect you to speak up.”
Build Trust Through Standardized Communications
Without trust between team members, leaders can't achieve peak performance. Professional pilots achieve high levels of trust by standardizing their communications and rigorously following standard procedures. Every team member knows exactly what to expect from their colleagues because they:
Use precise, standardized phraseology. This helps eliminate assumptions and cuts out unimportant, extraneous communication. Pilots use standardized callouts and responses to ensure critical information flows quickly and clearly without error.
Follow established protocols for all routine and emergency procedures. If everyone does things their own way, there is no "baseline of expected performance," and no one can predict what other team members will do. This leads to variability in team performance and, often, chaotic performance.
Conduct thorough pre-mission briefings and post-mission debriefs. When healthcare leaders adopt these practices, they ensure their teams know exactly what is expected before care is provided and have a standardized and structured process for providing performance feedback after the care is provided.
This standardization of communication and processes reduces the cognitive load on individual team members and allows teams to focus on managing unexpected challenges and events rather than basic coordination.
The Power of Mutual Support: We Succeed or Fail As a Team
Pilots live by the principle of 200% Accountability. We are always 100% accountable to check ourselves - are we doing the right thing in the right way at the right time to produce the right outcome. We are also 100% accountable to check others on the team - are they doing the right thing in the right way at the right time to produce the right outcome?
200% Accountability acknowledges that even the most skilled individuals are human and will make mistakes. Pilots acknowledge that when a problem is perceived, all members of the team have the responsibility to speak up, using respectful assertion until the problem is resolved.
Conduct Briefings and Debriefings to Create a Continuously Learning Organization
Perhaps the most useful practice leaders can adopt from professional pilots is their disciplined approach to briefing and debriefing. Before each mission, pilots conduct detailed briefings to align on objectives, roles, and contingencies. After each mission, they participate in debriefings where team hierarchy disappears in favor of honest and transparent feedback to promote improved performance.
This creates a continuous cycle of improvement that:
Sets clear expectations and alignment of actions before execution and
Allows the team to monitor actual performance against expected performance and close any observed gaps
Builds a sense of psychological safety where it is okay, safe, and expected to speak up when a problem is perceived
Provides routine, structured opportunities for self-assessment of observed performance
Creates a safe environment where team members can self asses and identify what, exactly, they will do to improve performance for next time
The Bottom Line
For both professional pilots and healthcare leaders, success depends on teams that make effective decisions quickly in uncertain conditions. By applying lessons from pilots, healthcare leaders can build more effective teams that reliably achieve desired outcomes.
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