If you are a leader who works anywhere in the realm of patient safety, there is a great chance that you are familiar with the commercial aviation industry. The aviation industry, as a whole, has a safety record that those of us in health care wish that we had! Commercial aviation is frequently cited as a so-called High Reliability Organization. In other words, despite the inherent dangers of flying, there are surprisingly very few accidents.
It's important to distinguish between "error-free" and "accident-free" here. While the aviation industry has done a great job reducing errors, errors still occur on a daily basis. As a matter of fact, most studies have documented that errors are made during every single flight. High Reliability Organizations, like the commercial aviation industry, minimize the impact of the errors that are made, resulting in "accident-free" operations.
Another important distinction is that High Reliability Organizations invest time, money, and resources in order to learn as much as possible when the rare accident does occur. It seems like every time that a plane has an accident (and again, this is very uncommon), the media starts asking a lot of questions about something called the flight recorder or "black box". This is actually a misnomer - the flight recorder isn't black. Instead, it is usually painted bright orange so that they can be easily found after an accident. There are actually two components to the flight recorder. The flight data recorder (FDR) records dozens of individual parameters (air speed, pitch, lattitude/longitude, wind speed, etc) several times per second, so that the recent history of the flight is preserved. Conversely, the cockpit voice recorder (CVR) records all of the sounds (e.g. alarms) and conversations between the pilots and air traffic controllers. Using the data from the "black box", investigators can determine what exactly happened to the plane and why it crashed.
I actually didn't know this, but after reading about the golfer Tiger Woods' recent automobile accident, I learned that cars now have cars now have data recorders. They've actually been around for quite some time! It's essentially the same concept as the "black box" used in aviation. Investigators can use the data stored by the "black box" to learn how and why an automobile accident occurred.
I know what you're probably thinking. Is there a health care version of the "black box"? The answer may surprise you. With the advent of the electronic health record, we have access to more data than we've ever had - but having access to data is not the same thing as having access to real-time event recorders like the "black box" used in aviation. I would say that here, health care has a lot to learn from the aviation AND the automobile industry. We are moving in that direction, but we're not there yet.
Just as important, in my opinion, is having access to a "black box" for leadership. I'm not talking about having access to second-by-second recordings of everything that is going on around you, similar to the flight recorder or automobile data recorders. Here, I am talking specifically about taking an in depth look at the decisions you've made, the conversations that you have had with your team, or the presentations that you make to your own supervisor. Leadership is a constant, never-ending, continual learning process. John F. Kennedy said that "Leadership and learning are indispensable to each other." He was absolutely correct. An important aspect of leadership is learning through reflection and analysis about your own performance.
Here's an example of what I'm talking about. Every time that I have the opportunity to go back and watch or listen to a presentation that I have made, I do so. Just this past Friday morning, I watched myself giving a lecture to our Department of Surgery on - you guessed it - "High Reliability Organizations"! I took the time to watch specifically to evaluate how I communicated, both verbally and non-verbally. I wanted to see if there are any points that I made that were confusing. Finally, I reviewed the slide deck that I used and watched carefully how the presentation flowed (in one case, I glossed over a slide so quickly that I have now taken it out for future presentations on this topic).
Leaders need a "black box" too. Take advantage of all the data that you have in front of you to learn how to become a better leader in the future. Chances are that we will likely never wear a "leadership black box" that records our every decision, but there is a good chance that we will have access to data that can help us become better leaders. As the American philosopher John Dewey said, "We do not learn from experience, we learn from reflecting on experience." We learn from our "black box."
No comments:
Post a Comment