Why Hospitals Should FLY - A Review

Author : Jordan Aronhalt

Why Hospitals Should Fly by John Nance is a fictional tour of a best-in-class hospital in Denver, Colorado. St. Michael’s Hospital, as it’s called in the book, is one of the safest and most highly regarded hospitals in the nation. The premise of the book revolves around a former executive director taking a week-long tour of the facility to figure out why the place holds its prestigious reputation, and to see if he is able to absorb some of their practices along the way. In tune with the title, the hospital is heavily influenced by safety measures introduced by airlines over the past fifty years. The parallel of aviation safety to healthcare is not uncommon; Atul Gawande uses the same concept in The Checklist Manifesto, which illustrates how the nationally adopted surgical timeout procedure came from airline pre-flight checklists.

"Culture kills the best of strategies" 

The book works as a narrative tour de force of the institution, each departmental tour given by the leaders those areas within the hospital. We learn how the culture of the team supporting pilots changed as a result of the Tenerife accident, and how physicians should be more like Captain Picard than Captain Kirk (of Star Trek fame, sorry Shattner).  The book provides examples of video feedback of physician behavior in the OR, and how people often don’t realize how they are treating others in the moment. The author also introduces the quality philosophy that “we will always make a mistake, so double check everything” and other principles to follow based on the psychology of human error.

"A leader is measured by how well they extract, orchestrate and utilize all the human talent available." (quote)

The book also sheds light on an important issue that can be difficult to discuss in articles and with the general population; how the structure of leadership and the economic system of healthcare have left us with a poor performing healthcare model. As many healthcare professionals can attest, part of the reason hospitals and healthcare is so expensive today is that historically facilities have been designed and shaped to accommodate physician’s needs, not patients. We have evolved from a cottage industry where all practitioners were free to do as they pleased inside the walls, to now striving for organizational standards of care based on evidence and stakeholder agreement. The field of healthcare continues to develop along these principles, and this book outlines a strategy for bringing that philosophy to your institution.

"We're guilty of practicing medicine without a collective memory!" (from Jack Silverman, the fictional CEO of the St. Michael’s Hospital)

Why Hospitals Should Fly is a practical and optimistic picture of what healthcare could look like in a high-functioning hospital. As a reader, there is a wealth of good ideas that may be useful to you and your facility, with examples and concepts found in the ED, OR, ICU and a not-so-standard patient unit. If you aren’t familiar with the aviation industry’s effects on healthcare, or just want to explore some different models of hospital operations, I recommend adding this book to your personal reading list.