BRIDGEPORT, Conn. — From the minute Joe Brown slides into the cockpit of an airplane, he’s in charge of protecting scores of lives.
Every decision the veteran pilot faces is crucial. He needs to know exactly what’s going on with his plane, what’s happening in the air and which member of his crew is in charge of doing what.
Everything has to go smoothly because if it doesn’t, one mistake could put all those lives — each one in Brown’s care — at risk.
In a way, it’s a lot like surgery.
Like passengers on an airplane, patients having surgery put someone else in charge of their safety. And like a pilot, a surgeon and his team must work together seamlessly. Everyone’s role has to be clearly defined. If something goes wrong, then a patient’s life — like those of the airplane passengers — is in jeopardy.
Given these similarities, it makes sense that hospitals throughout the region, from Bridgeport to Greenwich and beyond, are looking to the aviation industry and other complicated, high-risk professions to help them run more smoothly and safely.
One of the most dramatic instances of this is at St. Vincent’s Medical Center in Bridgeport, which hired Brown, an airline pilot for more than 20 years, as project manager of its new Transcatheter Aortic Valve Replacement program.
St. Vincent’s is one of the few hospitals in the state to have TAVR, a non-surgical heart procedure that takes about 2 1/2 hours to complete and involves up to 25 doctors, nurses and other medical staff.
Brown, who is also president of the New York-based health consulting firm, The Salus Network, said navigating TAVR and other complicated medical procedures is not unlike safely piloting an airplane. Both tasks require tremendous preparation and coordination.
“We say 95 percent of our job is boredom, followed by five minutes of sheer terror,” Brown said.
The idea of modeling health safety standards on other industries dates back at least to 1999, when the Institute of Medicine published its report “To Err is Human,” which examined medical errors and the environmental factors that can cause them. Part of the report compared the health care industry to other high-risk industries, including manufacturing and defense.
On the latter score, the report focused on U.S. Navy aircraft carriers, and how, on the flight deck of a carrier, 100 to 200 people fuel and maintain aircraft that take off and are recovered at 48- to 60-second intervals.
Even with all the variables involved in this complicated industry, workers have developed general plans and protocols that can be adapted to fit a given weather condition, visibility issue or other challenges that might arise. The report theorized that the health industry, where workers also have to often shift gears because of changing conditions, might benefit from similar plans.
Since that report came out, a number of techniques from the aviation industry have been used at hospitals throughout the country.
Some techniques are already used by plenty of people whose jobs don’t involve cutting someone open, or takeoffs and landings. For instance, when you use words to stand for letters when you’re spelling something — such as “B as in boy” or “A as in apple” — that’s an aviation technique.
In recent years, improving hospital safety has become a huge concern nationwide. Professionals look to prevent deaths from medical errors, which according to several studies, amount to between 44,000 and 98,000 lives each year.
On a state level, the Connecticut Hospital Association has made reducing errors a priority, said Mary Cooper, CHA’s chief quality officer. Last year, the association contracted with Healthcare Performance Improvement to help the state’s hospitals improve their safety standards.
HPI is a Virginia-based organization whose members include those from the health care industry as well as other high-risk industries, including aviation and nuclear power. HPI has led to safety improvement initiatives in 200 health care organization across the country.
HPI has done a variety of training sessions with staff at area hospitals, Cooper said, adding that the association’s ultimate goal is to instill a “culture of high-reliability” at the state’s health care facilities.
“That doesn’t happen overnight,” Cooper said.
However, many Connecticut hospitals have already adopted practices modeled on high-risk professions.
For instance, Stamford Hospital works with the Tennessee-based LifeWings, another agency that puts together the best practices of aviation and similar industries and applies them to health care. The program heavily emphasizes crew resource management, which is basically getting all the members of a health care team to communicate and work together fluidly.
Communication seems to be a key component of high-reliability. Another popular strategy modeled on aviation and other complex professions is the morning “safety huddle,” in which hospital leaders briefly gather to discuss any safety concerns and challenges.
“That’s a very common technique,” Cooper said. “Everybody has to stop and get on the same page.”
Those instituting safety huddles include Greenwich Hospital, Bridgeport Hospital, and many others. Greenwich Hospital chief safety officer Stephen Jones said keeping patients safe is a top priority at all hospitals.
“It’s an obsession with making sure that you do anything you can to put the correct systems in place,” he said.
Other aviation techniques instituted by local hospitals include the idea of a pre-flight checklist, in which a flight crew makes sure all of the essentials are in place before taxiing and takeoff.
In the health care industry, such a checklist might start with something as basic as confirming the patient’s name and confirming the procedure before moving on to make sure all the necessary equipment and staff are in place, said Dr. Keith Zuccala, chairman of the department of surgery for the Western Connecticut Health Network. The network, which contains Danbury Hospital and New Milford Hospital, has taken on other aviation techniques as well, including “debriefing” after procedures.
Zuccala explained this is actually a military aviation technique, but it’s still a good example of using tactics from other industries to improve health care.
“It’s all about getting it right and patient safety,” he said.
But some organizations have taken that commitment to safety a step further, including St. Vincent’s Medical Center, according to many of its peers.
Brown came to St. Vincent’s a few months ago to help launch its new heart procedure, which involves a variety of medical disciplines, including vascular surgery, anesthesiology and radiology. Brown said his challenge, as with flying a plane, was making sure everyone involved in every procedure knew what was expected of them.
“It’s not unlike bringing a new aircraft into service,” he said.
One technique Brown has implemented is the “call out,” which is when the leader of a given procedure calls out and takes charge overall. In other words, Brown said, “someone is always flying the plane.”
Brown also had the hospital install a flat-screen TV in the operating room, which functions the same way a GPS might in a plane, displaying which step in the procedure the team was addressing.
Other changes include assigning staff from each discipline a different-colored surgical cap. For instance, anesthesiologists wear blue caps. Vascular surgeons wear red, radiologists wear black and so on. That way, the staff from each department is easily identifiable.
Dr. Robert Jumper, an interventional cardiologist who leads the TAVR procedures, said Brown’s techniques have brought clarity to the complicated operation.
The hospital has been doing TAVR for about a month and Brown’s contributions have helped to make it a success, he said.
“Giving us the ability to coordinate that many people to move in a precise fashion is what Joe has brought to the table,” Jumper said.