The recent Boeing 737 airline crashes have left a scar on the American (and worldwide) psyche regarding air travel. Boeing, an iconic brand, prestigious in history and talent, neglected to update and formally educate pilots regarding an essential software update which ultimately contributed to two fatal crashes, killing 346 people in total.
Recent audio between an American Airlines pilot and Boeing’s leadership offers some insight — and lessons — into this tragedy. While concerned pilots were questioning Boeing’s software changes shortly after the first 737 crash, the pilots were simply met with resistance and largely dismissed by Boeing officials. The pilot’s (rightfully) argued for full training and widespread education regarding these software changes as mandatory before flying the 737 Max.
Boeing’s response? “I don’t know that understanding the system would’ve changed the outcome of this … maybe once you’re going to see this ever.”
Four months later, a second 737 aircraft, carrying 157 people crashed, killing everyone on board. Boeing (under orders from the Federal Aviation Administration) has since grounded its 737 Max aircraft. The company has since admitted their mistake in failing to communicate these vital software updates which are largely attributed as the main cause of both crashes.
A lesson in leadership: Who runs the show?
For the record, I am not picking on Boeing. But these unfortunate (and very public) tragedies highlight a very important lesson for any company, hospital or enterprise when it comes to leadership and crisis aversion. A quick stroll through Boeing’s board of directors shows there are no pilots or engineers included.
How is this possible? How can a company, whose central product relies on the endless hours, calculations, and research from an engineering and manufacturing standpoint not include at least one product expert on their leadership board? If a pilot or engineer were on that board, would they have urged the company to immediately halt all aircraft after the first crash?
What can Boeing’s corporate leadership tell us about leadership and crisis aversion? In corporate-dominated health care, can Boeing’s leadership give us an example and insight for the delivery of health care? What can hospitals learn from successful corporations (Google, Apple) while avoiding the mistakes of others?
Hoodies over suits; Innovation over money: Learning from Silicon Valley
It should not come as a surprise that having “product” experts in positions of power will help deliver a superior product. Perhaps the most colorful example of this is in Silicon Valley.
Google, arguably the most transformative company of our generation, has staunchly (and necessarily) held its original owners (both computer programmers) as business heads of the company. It remains essential, for Google’s business and culture of innovation, to have product experts as heads of the company to deliver a cutting-edge product.
In Silicon Valley, this mantra remains sacrosanct: you never risk delivering a sub-par product in exchange for cost expenditure.
Steve Jobs was a prime example of this, often obsessing over the most minute, esoteric details. One particular story (involving a prominent Google executive) sums up the level of detail Jobs, also a software developer, had over his company. And just like that, in the blink of an eye, Silicon Valley helped transformed corporate culture from a suit-wearing, business-infatuated one to that of CEOs wearing “hoodies and sweatshirts” focused on innovation and creativity.
Are there examples of such product leadership in health care? Can models focused on delivery of quality care, workplace culture, and innovation be implemented in health care?
Doctor-led hospitals: a prescription for success?
A quick study examining the history of health care delivery and hospital models in the U.S. proves precisely the point that “doctor- (expert-) led” hospitals are in fact superior models for delivery of care.
Two of our nation’s largest hospital networks, Mayo and Cleveland Clinic, are physician-led hospitals, meaning that doctors play a vital role in hospital management and governance. As a disclaimer, I am employed by a “physician-led hospital,” although I have held the notion that doctor-led hospitals as superior models even as a trainee.
Is this why Mayo Clinic the Cleveland Clinic are consistently ranked the number-one and number-two hospitals nationwide? Piling on to the evidence is the fact that physician-led models are in fact more cost effective. Having experts in controls simply helps maximize our return on investment while spending (and investing) on what is truly necessary.
Let’s entertain the following examples: Think about a surgeon, who’s lifework was built, quite literally, stitch after stitch. The same surgeon is now mandated to increase their surgical volume to be more “cost-effective.” Only someone who understands and values the intricacies of surgical detail and safety will understand the pressure of hastily increasing surgical volume while inadequately investing and preparing for that increase in volume.
Or perhaps a physician anesthesiologist, who is now pressured to supervise four operating rooms instead of two to “save on operating costs.” How will that anesthesiologist accommodate the safety of adequately screening patients preoperatively while balancing the increase in volume?
A surgeon or physician anesthesiologist CEO can immediately transport themselves into the operating room at the blink of an eye. Just like a soldier in combat gear, the surgical scrubs never really come off, no matter what the setting. Similarly, a pilot CEO, understanding the pressure and intensity of the aircraft cockpit, would have perhaps been more intent on listening to pilot’s concerns regarding the 737’s software updates.
More importantly, and ultimately central to our mission as physicians, is how a culture of patient safety (and physician well-being) can be potentially affected by having doctors as leaders. Unfortunately, when doctors, pilots or engineers are omitted from leadership positions this represents not only missed opportunity for innovation and leadership but a missed opportunity for the inspiration of future leaders.
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