What Airplane Pilots and Surgeons Have In Common: How Structure Enables Safety

Untitled designIn many high performance jobs, the tasks are done in as standard a manner as possible. Following a precise set of procedures accomplishes a number of things: It helps to ensure the best possible outcomes (assuming the procedures are based on evidence of what’s worked well in the past), it helps to ensure that no steps are missed, and it protects people and companies from legal repercussions if something does go wrong. I believe highly structured work also has an additional benefit: It makes it easier to spot when something is going awry and take appropriate, even creative, action.

Take the example of airline pilots. In Skyfaring: A Journey With A Pilot, Mark Vanhoenacker writes:

The interaction and cooperation between the two different pilot roles–pilot flying and pilot monitoring–is highly formalized. Not only the tasks but the language that accompanies their completion is specified in exacting detail . . . The teamwork that flows from such clearly demarcated roles shapes everything about our hours in the cockpit.

With such clearly defined tasks and roles, it is hard for pilots to overlook situations out of the ordinary. The formal structure around flying commercial aircraft is likely one of the reasons that flying remains one of the very safest ways to travel. (If you feel doubtful about this after reading about plane crashes in the news, bear in mind that one reason plane crashes make the news is because they are statistically rare.)

I first heard about a similar coordination among workers in a high risk job when I took a class in grad school with Karl Weick at the University of Michigan. Karl wrote a paper called Collective Mind in Organizations: Heedful Interrelating on Flight Decks about teams that work on aircraft carriers guiding planes to take off and land.

Karl calls groups like the aircraft carrier teams “high reliability organizations.” The margin for error on their tasks is very small, and all of the members of the aircraft carrier crew have to be tightly coordinated to be successful. Part of how they achieve this is through a very strict and detailed set of standard practices that they follow, so that any one worker can assume at a given time what his coworkers are doing, and be right. If something goes wrong, just as with the pilots, others instantly become aware because their typical pattern is disrupted.

The use of formal procedures to handle complicated and high-importance tasks has been so successful in industries like aviation that it’s making its way into the operating room. A few years ago, Dr. Atul Gawande published The Checklist Manifesto, an impassioned argument for the use of checklists in medical practice to help standardize procedures and more quickly detect potential errors. The book, to put it mildly, was noticed by the medical field. Its publication came at around the same time that the Affordable Care Act was putting attention on medical errors and hospital readmissions, and restructuring payments to minimize them. I would be surprised if we didn’t see American hospitals looking more and more like American cockpits over the next decade or so.

By focusing attention on how things should look, formal procedures help us recognize and take action earlier when something isn’t right. Generally speaking, the earlier you recognize a problem, the more options you have to fix it.  By making issues evident early, I think process can help enable creative problem solving alongside its many other benefits.

2 thoughts on “What Airplane Pilots and Surgeons Have In Common: How Structure Enables Safety”

    1. Thanks for sharing the link to your site–there’s a lot I’m excited to read there. And so true that we have to balance structure with keeping people engaged and interested. It’s fascinating to see how our brains interact with new technologies.

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