Dr. Haynes likens surgery to another high-risk profession — aviation
— where an instance of someone lacking the courage to speak up
could lead to unimaginable disaster. "A co-pilot may be aware that the
pilot is ready to fly the plane into the ground, but he's not willing to
issue a challenge," he says. "That's rooted in issues pertaining to cul-
ture and hierarchy, and it has nothing to do with common sense."
Spence Byrum appreciates the aviation analogy. He's the president
and CEO of HRS Consulting, a Weston, Fla.-based firm founded to
help the airline industry improve communication and safety. The firm
has since branched out to health care, helping surgical facilities bring
similar disciplines to the OR.
"In aviation and in surgery, all the risks are the same, and all the
challenges are the same," he says. "You have a limited number of
individuals tasked with performing tasks where lives are on the
line, working in environments with constantly changing informa-
tion. So many things could go wrong."
That's why adequate pre-procedures are so essential. In aviation,
pilots have a team of individuals around them to alert them to poten-
tial problems (see "What Safety Lessons Can ORs Learn from the
Airlines?" on p. 39). Why should surgery be any different?
"An organization has to clearly and explicitly tell its employees that
they are expected to speak up if they see something wrong," says Mr.
Byrum. "Part of it is teaching employees when to say it, how to say it.
You also can't take away the responsibility of the decision maker,
because he has to be able to receive the information and assimilate it
to determine how to proceed, and all that happens in just a few sec-
onds."
Mr. Byrum suggests surgical facility leaders teach staff to take a
straightforward, multi-step approach to speaking up when they see
something that could become a problem: Get the decision maker's
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