In this thoughtful and interesting article from Hospital Impact, John Burroughs suggests six things healthcare systems could learn from the airline industry. We agree with and often repeat many of his key points: That hospitals must view healthcare operations and flow as a system, not a set of discrete units or departments. That hospitals teams should plan and schedule discharges (and to a large degree admissions) in advance, creating a system where the anticipated discharge is always “pulling” the patient’s care activities toward successful, timely outcomes and post-acute transitions.
Some of the commenters, however, don’t seem to like Dr. Burroughs’ article at all. And they don’t just politely, reasonably disagree with his perspectives; some people express outright hostile, almost personal reactions to the very suggestion that healthcare could learn something from airlines or any other industry. Several directly challenge Burroughs’ hospital operational knowledge and experience:
- “With all due respect, you know very little about hospital operations.”*
- “You’ve written 6 points that say nothing. As a nurse of 20yrs, all I can say is you have no idea what you’re talking about. “
- “The article is laughable.”
- And at least one frustrated air traveler took the opportunity to vent about his flying experiences: “The airlines have mastered what?? Families begging me to give up my seat that I had to pay an extra fee for on checkin to assure I wasn’t shoe horned in the torturous middle seat for 4+ hours?”
To his tremendous credit, Burroughs thoughtfully answers his critics, clarifying both his legitimate credentials and the application of his suggestions in healthcare. Many others also chime in with positive comments about how airline management and logistical practices could serve healthcare well, and shared their appreciation for the article and the ideas. But the less friendly responses are telling and reflect something that we encounter sometimes in healthcare: Resistance to any new ways of thinking or approaches to patient care and throughput. We understand it; often people have committed their lives and careers to providing exceptional, compassionate patient care, and they are wary of executives or outside experts who seem to be suggesting that patients are like planes or widgets.
But that’s not at all what we mean when we suggest that healthcare could learn from the logistical approaches of airlines or transportation companies or manufacturers. A logistical approach is a patient centered approach–it does not marginalize the clinical care of the patient at all. The patients’ responses to treatment will always be variable, even though the activities and throughput milestones are largely the same for every patient. We only suggest that when hospitals focus on successfully advancing those milestones faster, they will better serve the clinical care and outcomes of all patients. Centralized care coordination and better communication among caregivers and departments eliminate bottlenecks and administrative tangles. This frees nurses and doctors to spend more time at bedside and less time on phones or scurrying to track down patients and order results. Patients are consistently happier when they receive attentive, appropriate care, with a clear itinerary, while spending the shortest amount of total time in the hospital. Daily huddles with all of the appropriate caregivers keep individual patient care plans and overall throughput targets on track.
“Transformation” is one of those buzzwords that can lose its meaning from overuse and familiarity. For hospitals, though, it’s the precise characterization of what they must do to thrive in providing better quality care at lower costs. They must fundamentally transform the way they think about, approach and deliver care.
So we expect hospital executives and caregivers to challenge new approaches and ask tough questions about how operational practices from other industries apply successfully to patient care and throughput. But we encourage them to at least keep an open mind. Reactively dismissing lessons and ideas from outside of healthcare might defer or derail the dramatic improvements hospitals seek in throughput, quality and patient experience.
POSTED BY Doug Walker
*Does anyone ever follow “with all due respect” by saying something respectful?