Well, we made it back from Switzerland last night (see last blog post for details on the trip "We are more alike my friends..."). We flew on an airline that I usually don't fly, for multiple reasons (Reason #1 - I have a frequent flyer account built up on another airline; Reason #2 - I have had multiple issues with this particular airline in the past; Reason #3 - I happen to like the airline that I usually fly). Well, the airline, which shall remain nameless for the moment, did not fail to disappoint. They met my very low expectations yet again. One member of our family got to the airport in Zurich and didn't even have a ticket to go home (the airline canceled the return flight when we had to re-schedule our flight to Switzerland due to the blizzard in the Northeast last week). Luckily she did end up getting on to the plane without too much trouble. We were late pulling away from the gate because they had to search and remove some baggage from another party that missed their connection and were not on the flight. Once that was squared away, the auxiliary power gave out and had to be repaired and inspected (never mind that the airplane we were flying on was built well before the turn of the century!). We ended up leaving an hour late, which meant that two of us had to race through customs and immigration, baggage (which took forever!), and TSA to get to our gate, just in the nick of time. It turns out that two other members of our party had issues with their connecting flights as well. What a mess. I guess we did all make it home, and we all got our baggage - so not a complete failure.
Why am I blogging about all of this? Well, as it turns out, there were two things that really struck me as pertinent to hospital operations. First, my daughter mentioned to me while we were sitting on the tarmac in Zurich, "Do you think maybe they should have known about a failure in auxiliary power long before the moment that they were getting ready to pull away from the gate?" She was absolutely correct - shouldn't this have been something that they picked up during their initial pre-flight checklist? I don't know too much about planes, but "auxiliary power" sounds pretty important. You would hope that a failure in a system of this level of importance would be identified much earlier than right before pulling away from the gate. I hear of cases all the time at hospitals in which pre-procedural time-outs are not followed, either because the physicians are too busy or the procedure is being performed emergently. We have checklists for a reason - they are there for exactly the times when we are rushed because we are busy or the procedure is emergent. Things like a failure in "auxiliary power" should not happen with airplanes, and pre-procedural time-outs should never be skipped because we are too busy.
Second, when we landed in New York's John F. Kennedy International Airport over 60 minutes later than expected, we were greeted by airline representatives dressed in purple jackets (the flight attendants told everyone as we were getting off the plane to talk to the "people in the purple jackets" if you have a connecting flight). Those people in the purple jackets had our connecting information and a bright orange card that said "Express Security" with our connecting gate information and a back-up plane ticket if we missed our connecting flight. We essentially were taken to the head of the line for customs and immigration and for TSA, and the individuals told us exactly how to get to our next gate and how long we had. My first impression was, "Wow, what great service recovery." Again, one of my daughters commented, "They really have this down - it must happen all the time!" She was absolutely right! The airline had developed a complete work-around for something that should be a rare occasion (a late flight). Do not get me wrong, no airline is perfect. We should never hold an airline accountable for bad weather (case in point - the recent blizzard that hit the Northeast United States last week causing a number of flight delays and cancellations). We should not expect that airlines will be on time 100% of the time. However, when you are late so many times that you develop a work-around system for service recovery, I think that is a problem. How many times do hospital staff develop and perform a work-around for something that shouldn't be allowed to happen? It happens more than it should, and that's a problem for two reasons. When hospital staff develop work-around processes, they usually fail to notify anyone of the problem that necessitated the work-around in the first place, so no learning occurs and the problem never gets fixed. In addition, work-around processes are usually slower and less efficient than how a process should work, which compounds inefficiency and can lead to additional problems down the line. We shouldn't need "people in purple jackets" in our airports or our hospitals!
I am amazed again on how much there is to learn through simple observation of other industries outside of health care - both the good, as well as the bad. We have learned a lot from commercial aviation, and our hospitals are safer as a result. But there are some things that we should never learn from the aviation industry, and yesterday gave me two clear examples of what not to do in health care.
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