Top Scalpel

Too many medical errors happen because of lousy communications. To help fix that, health care is looking to the skies.

Teaching medical staff to work like a flight team Brain surgery isn’t rocket science. But perhaps it should be. If medical staff worked together as a flight team does, they’d communicate more effectively, make fewer mistakes, and lose fewer lives.


That’s the idea behind LifeWings, a one-year-old company that applies flight-tested safety lessons from the aviation industry to the world of medicine. Doctors, nurses, and technicians learn–from pilots and others with lives-on-the-line flying experience–how to perform under pressure as a team.

Crew resource management training, as it’s known, caught hold in health care following a 1999 Institute of Medicine report that said 98,000 patients die each year because of medical errors. LifeWings’ president, Steve Harden, a former navy pilot and Top Gun instructor, spun the company out of a training program originally created for FedEx employees. “Human beings will eventually make errors,” says Harden. “But you can equip them with communication behaviors that help detect and correct those errors before they become serious.”

Those behaviors start with checklists. LifeWings requires medical teams to create standardized lists of activities for every procedure to ensure, for example, that the right patient is being treated. “If there’s a variation” from the checklist, Harden says, “you notice it immediately, because it doesn’t feel right.” He also insists on regular briefings between teams, ensuring consistent care when patients are transferred between departments.

And if there’s a problem, even the team’s most junior members are trained to say something. That’s tricky, since it means confronting medicine’s doctor-as-deity culture. “It’s sort of like giving permission to speak up,” says Jennifer Baer, senior director of outcomes and performance improvement at the University of Texas Medical Branch at Galveston, who went through the six-month training last year with 627 other staffers. “Something as complicated as an OR procedure requires everyone being able to pick up on things that could lead to problems.”

LifeWings has trained staff at more than 40 health-care organizations. Aside from a decline in the number of wrong surgeries (one hospital went from one every 60 days to one every 619, Harden says), the sessions tend to lift morale, leading to lower nurse turnover and increased efficiency. One hospital, says Harden, saved more than $100,000 a year after learning that sterile surgical kits were being opened but never used.

Of course, better communication can go just so far, observes Karlene Roberts, a University of California, Berkeley, business professor. Without support from employers and better med-school training, “we’re going to be stuck with the same situation.” Which is why Harden now insists on training a hospital’s top brass first, to ensure the checklists and briefings become part of a permanent culture change. “This is not,” he says, “a fire-and-forget program.” That’s pilot talk–but docs seem to get it.