Cincinnati Children's Blog

Lessons from an aircraft carrier

January 27, 2011

One of the defining elements of our culture at Cincinnati Children’s is a nearly fanatical focus on safety. While we’re proud of our record and the expertise we’ve developed over the years, we also believe we can learn from others.

For several years, I’ve been told by safety experts that aircraft carriers are a great example of a High Reliability Organization, or HRO. The Navy has significantly reduced safety risks over the last 30 years while performing incredibly dangerous activities.

Along with 14 other civilian visitors, I recently spent two days studying operations aboard a Naval aircraft carrier.  Here’s what I learned that can be applied at Cincinnati Children’s and other healthcare organizations:

1) There’s No Hierarchy On Deck
No one dresses by rank on the flight deck. Uniform color signifies role, not rank. The pilots are just one member of the team while on the flight deck. The other 5,000 people on board can cross their arms at any time and stop a launch. Not only can they stop a launch due to safety concerns, they are expected to.

2) Empowering People Means Rewarding Good Catches
During one landing, a piece a paper floated up onto deck. A young trainee raised his hand immediately, dozens of other hands went up on deck when they saw his, and the landing was aborted. During the commanding officer’s daily address that evening he called out the sailor by name and thanked him. On board, the number-one way to get in trouble is to demean a sailor for raising a safety concern.

3) HROs Use Peer Rating
Pilots are rated by other pilots on each landing. Every pilot’s safety record is displayed on the “Wall of Shame.” They believe in transparency. Safety records are significant in evaluations and promotions.

4) Briefs and Huddles
All over the ship, crews met briefly to discuss concerns and the upcoming plan. They felt it was crucial for everyone to know what was going on in real-time. The commanding officer held two briefings per day, and department heads were expected to know what was going on in their department and predict any concerns.

Cincinnati Children’s is now expanding daily huddles throughout departments and units. Each morning we have an organizational Daily Safety Brief.  On this call, about a dozen departments and clinical areas discuss safety risks and plan for the next 24 hours.

We’re on a high reliability journey at Cincinnati Children’s, and we are dedicated to this as fundamental to our mission. Along the way we will continue looking to other organizations – even aircraft carriers – to learn more.

Stephen Muething, MD, is a Pediatrician and Associate Professor at the University of Cincinnati and Cincinnati Children’s. He has recently taken on a leadership role as Vice President of safety at Cincinnati Children’s because of his experience in design for reliability and high reliability organizations.


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