# Why Hospitals Should Fly  ## Metadata - Author: [[John J. Nance]] - Full Title: Why Hospitals Should Fly - Category: #books ## Highlights - “Perfect safety, by the way, doesn’t mean eliminating all mistakes. It means structuring a system that expects and safely deals with mistakes, both the type that can do immediate harm and those that can kill slowly ([Location 154](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=154)) - “Catch,” not “ ([Location 247](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=247)) - But there was a huge problem with this type of traditional reasoning: Jacob was the best aviation had to offer. ([Location 442](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=442)) - Behind Every Disaster is a Tragically Flawed Assumption ([Location 468](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=468)) - Perception, Assumption, and botched Communication. ([Location 471](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=471)) - There is never just one cause, and no such thing as a root cause, in any medical disaster or near-disaster. While the systemic element does not cancel the need for maintaining an accountable professional responsibility, future disasters from similar causes will only be prevented by addressing and fixing every single contributing factor. ([Location 493](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=493)) - They’ve also given us tragic evidence that a group divided against itself by professional jealousy, stratification, or just inability to communicate, is doomed to fail. ([Location 758](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=758)) - that, ‘Culture kills the best of strategies. ([Location 763](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=763)) - practice autonomy is a dangerous idea. The concept of practice autonomy itself may not be a good thing, especially from a patient safety point of view. 2. Aligning the corporate bylaws of a hospital with the bylaws of the medical staff may be the key to having clear authority to enforce standards and best practices. 3. Physicians can do almost as much damage to nursing morale by not speaking or interacting with them as they can by yelling or being disruptive! I doubt a tenth of the physicians in the United States have ever considered this. These are called “covert” or “absent” behaviors. 4. Great quote: “Culture kills the best of strategies.” 5. True teamwork depends on collegiality and mutual respect. And patient safety in turn depends, to an inordinate extent on teamwork. ([Location 770](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=770)) - But the built-in protective bias that works is when we truly expect without variance that the order is wrong until proven right. ([Location 887](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=887)) - “Really? You have an institutional expectation of failure?” “Every single time. ([Location 888](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=888)) - When the team makes a decision, upper management had better have an overwhelmingly good reason for reviewing it, let alone trying to reverse it by fiat. In fact, we don’t allow management changes by fiat, except for dire emergencies. If the director of the ER doesn’t like a change, she asks ([Location 905](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=905)) - Try this: Would you fly on an airline that let their captains decide individually whether to use flaps or checklists, or turn on all the engines for takeoff? ([Location 944](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=944)) - perception, assumption and communication. ([Location 1024](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=1024)) - Will’s Notes: 1. Since human infallibility is impossible, the only chance to keep human errors from hurting patients is by creating collegial interactive teams (CITs). ([Location 1137](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=1137)) - hospitals should be employing time-outs, ([Location 1721](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=1721)) - There are times when a leader has to operate as a commander, such as when directing a code, but most of the time a true, effective leader leads by listening, and gathering and filtering information and advice, as well as facts, in order to make superior decisions. ([Location 2070](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=2070)) - And I’ll wager you that’s the case all over the nation, hospitals filled with people of true talent and heart just waiting for someone to give them the support and the impetus to overhaul their culture. ([Location 2547](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=2547)) - Culture change is exponentially faster when the culture itself decides to make the change. ([Location 2614](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=2614)) - every system is perfectly designed to get the results it consistently achieves? ([Location 2663](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=2663)) - We document what changes, what goes wrong, what needs attention, not the fact that the sun comes up in the east every morning and the patient is still breathing. ([Location 3153](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=3153)) - As George Halvorson points out in Healthcare Reform Now!, out of thousands of billing codes for thousands of medical services, there is not a single one for “ ([Location 3325](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=3325)) - That’s not a moral failure, it’s a structural failure, ([Location 3327](https://readwise.io/to_kindle?action=open&asin=B004NSV83S&location=3327))