I’ve Been Thinking about books, films, Aristotle, and the importance of pulling together when it comes to achieving patient safety

The Whole Is More Than The Sum Of Its Parts

January 2009

I’ve been thinking about books, films, Aristotle, and the importance of pulling together when it comes to achieving patient safety.

If you haven’t read best-selling author John Nance’s latest novel, you must. In Why Hospitals Should Fly, aviation-safety expert Nance maps “the ultimate flight plan to patient safety and quality care.”

Jack Silverman of St. Michaels, a fictional hospital in Denver, is a CEO driven by deeply personal encounters with medical mistakes. In his passion for mentoring others in patient safety, Silverman draws not only from his own experience as a physician but also from the invaluable safety lessons learned from the airline industry that apply to health care.

Silverman renders, with commentary, a detailed account of the world’s worst civil aviation disaster. On March 27, 1977, on the small island of Tenerife off the horn of Africa, two 747s collided, killing 583 people.

I will let you read the account for yourself, but in a sentence, Dr. Silverman concludes that the planes crashed essentially because a captain “discounted the value of operating as a crew.” He failed to listen to other crewmembers who knew some critical things he didn’t.

Dr. Silverman applies the lessons learned to hospital personnel. “The norm must be collegiality and dependence on one another, regardless of who has what degrees.” Under his watch, Silverman determines that each staff member at St. Michaels will be “an equal partner in working toward the common goal of doing the best for the patient.”

Recently, Seattle filmmaker, Lenville O’Donnell (On Native Soil), showed me clips from his latest project. Rough Water: Odyssey behind the Iron Curtain, chronicles the remarkable exploits of the 1958 University of Washington rowing crew. In the height of the Cold War, the Husky varsity-8 became the first U.S. athletic team to compete and win in the Soviet Union. The shocking upset made headlines around the globe, and sportscaster Keith Jackson maintains it is still the most memorable sporting event of his legendary career.

O’Donnell, himself a member of the Husky crew in the 1970s (who still gets up each morning before dawn to row), explains the importance of teamwork. “Rowing is the only sport I know of in which every person on the team has to do exactly the same thing at exactly the same time in order to be successful. To go fast, everyone has to pull hard, but it’s even more important that everyone pulls together.”

I’ve also been reading rower/author Craig Lambert’s Mind Over Water, in which he claims that “lessons learned afloat carry over to dry ground.” While my experience is limited to the grandstands and an occasional tug on the rowing machine at the gym, what he says makes sense to me: “Victories by rowing crews, like other crews, generally result from teamwork. A fast boat of eight rowers and a cox attains a power that transcends its nine separate individuals.”

Silverman, O’Donnell, and Lambert have this in common—they agree with Aristotle. “The whole is indeed more than the sum of its parts.”

Although Why Hospitals Should Fly focuses on the need for teamwork in clinical practice, my experience tells me that teamwork is also essential when it comes to the task of selecting the right automation systems as well as implementing and using them the right way.

Too many automation decisions have been made autonomously, resulting in failure because one discipline discounts the value of operating as a crew with the other stakeholders. It is foolish (if not dangerous) when pharmacy makes ADM decisions, nursing makes BPOC decisions, IT makes information-system decisions, or materials management makes smart-pump decisions without incorporating the wisdom and insight of the others—regardless of who has what letters behind their names.

As cofounder of The unSUMMIT for Bedside Barcoding, you can imagine how pleased I am that John Nance and Len O’Donnell will be the keynote bookends of our next meeting in Tampa—May 6–8, 2009. In between these inspiring sessions, attendees will benefit from presentations by and shoulder rubbing with experienced crewmembers from all the relevant disciplines. Here’s a link to the brochure.

Add your interdisciplinary team to this mix. I assure you that the value will be greater than the sum of those who attend.

What do you think?

Mark Neuenschwander

Copyright 2009 The Neuenschwander Company