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Wouldn't it be nice if a hospital could operate as if on autopilot, with all its processes so sharp that errors would be reduced to a bare minimum?
That's the objective of LifeWings® Partners, a company founded by pilots to give hospitals and other healthcare provider organizations a flight plan for success.
Based in Memphis, Tenn., LifeWings boasts clients such as these:

• A hospital that reduced by half its number of medical errors.
• A hospital that reduced its number of wrong surgeries to 0.15 per 10,000 procedures, a rate more than 10 times better than the national average.
• A primary care clinic that reduced patient wait times by 10 minutes per appointment.
• A hospital that vastly improved the administration of pre-procedure antibiotics. The result was an increase in compliance from 68 percent to 96 percent and, thus, fewer post-surgical infections.
• An inner-city clinic that improved diabetes care.
• Several hospitals that reduced turnover of employees, especially nurses.

"What really drives us and what makes us so passionate about it is we've seen some really dramatic results in hospitals in terms of reduction in errors, improvements in care and the number of lives that are saved," said LifeWings president Steve Harden, who predicts the company will quadruple in size this year.

Harden flew Navy fighter jets and was an instructor at the United States Navy Fighter Weapons School, known as TOPGUN. Yes, that TOPGUN. After active duty in the mid-1980s, he joined Memphis-based FedEx as a pilot and was instrumental in designing the crew resource management course for the FedEx pilots. The idea was teamwork among all members of the crew, and FedEx found that the training was "very successful in reducing the number of errors and accidents," he said. Based on the strategy, Harden and a partner launched their own company, Crew Training International, focused on military aviation organizations.

Seven years ago, the company took an interesting turn. The director of the emergency department (ED) at Saint Francis Hospital in Memphis called Harden after reading about Crew Training International in a newspaper. Harden recalled that he said, "Hey, it sounds like what you guys do could really help us in the emergency department. Would you mind coming down here and taking a look?"

Harden said the idea "sounded kind of intriguing." After three days in the hospital's ED, he left with two impressions: "They had exactly the same kinds of problems that we have in commercial aviation in terms of teamwork and coordination and collaboration and communication, and the types of people we saw there were exactly the types of people who were attracted to aviation — a lot of type A, very driven personalities, control freaks, if you will. It was like you had taken the folks out of an airplane and put them in the hospital."
The company's consultation was a success, word spread and the next project was with another hospital's neurosurgical team. As demand from healthcare providers grew, LifeWings Partners spun off from Crew Training International two years ago. So far, the company has served more than 60 clients, including hospitals, ambulatory surgery centers, physician group practices and physician insurance companies.

"The real purpose is to increase the level of safety for both the patients and the staff and thereby improve the quality of the healthcare that you provide. In order to do those two things, you really have to decrease the number of errors, which is the main thing that's impacting the level of safety," Harden said.

Process engineering is key to the success, "to engineer the errors out of the system," he explained. The approach is two pronged: "to give healthcare providers the skills to work more effectively with peers and staff, and also work on the system in which the healthcare provider works so the system isn't error-prone," he said.

LifeWings' standard program has five components, which are customized to each client. They are:

1. leadership training
2. teamwork skills
3. Hardwired Safety ToolsSM that introduce aviation's best procedural practices, such as systematic checklists
4. a plan to measure improvements and return on investment
5. "train the trainer" sessions to continue the work

"We really don't like to do a program without doing leadership training," Harden said. "Ultimately, what this is, is a cultural change in the organization, and if you don't train the leadership, then it's not going to work. You have to give them the skills they need to lead the project, implement it and make sure it's sustainable."

Harden said employees are included from the get-go. The team goes through "a very definitive series of questions" about problems and what needs to be fixed. "Then we help them build the tools that are going to help fix those problems," he said.
"To be brutally honest with you, you can be very, very effective if you do three things when you're providing care as a team," Harden added. They are:

1. If you're the leader, look at the team at the beginning and say, "If you see anything that doesn't look right or causes you concern about the care we are giving this patient, I expect you to speak up and bring it to my attention." It's a very simple statement, but it's very powerful and catches a lot of errors.
2. If you're a team member, be prepared to say, "Doctor, I'm concerned and here's why."
3. If you are the leader — and if there's time — ask, "What do you think?"

"There needs to be a lot of structure in place to support those kinds of statements, and there needs to be leadership and follow-up," Harden said. "Behavior that gets rewarded gets repeated. … Ultimately if you get your teams to do those three things, you will have made tremendous progress."


June 2007

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