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Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety (The Culture and Politics of Health Care Work) Paperback – December 18, 2012

ISBN-13: 978-0801478291 ISBN-10: 0801478294 Edition: 1st

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Product Details

  • Series: The Culture and Politics of Health Care Work
  • Paperback: 272 pages
  • Publisher: ILR Press; 1 edition (December 18, 2012)
  • Language: English
  • ISBN-10: 0801478294
  • ISBN-13: 978-0801478291
  • Product Dimensions: 0.8 x 7 x 9.8 inches
  • Shipping Weight: 1 pounds (View shipping rates and policies)
  • Average Customer Review: 4.7 out of 5 stars  See all reviews (12 customer reviews)
  • Amazon Best Sellers Rank: #323,673 in Books (See Top 100 in Books)

Editorial Reviews


"An excellent account of the history of crew resource management (CRM), its virtues, and how it's supposed to work, the book also delivers an eye-popping look beyond the supposedly sterile drapes in some of the United States’ most prestigious hospitals. Approximately 100,000 patients die in the U.S. every year as a result of medical mistakes, and some of the behavior that goes on in the U.S. healthcare system, as described in the book, is appalling. 'Health care needs . . . a radical cultural transformation, like the one that has taken place in aviation over the past 30 years,’ the authors argue persuasively. Three positive case studies show that it can be done."— Jan W. Steenblik, Air Line Pilot (July 2013)

"This book is full of information from air investigations and interesting facts. The first flight attendants, for example, had to be registered nurses in case any passengers became unwell. It shows that the everyday implementation of such things as checklists is part of a commitment by an industry to change the way it works. This commitment comes through leadership, but involves all the team, and is key for a nursing audience."—Dan Wolstenholme, Nursing Standard (July 2013)

"This is the fascinating story of the development and implementation of Crew Resource Management (CRM) in aviation and how it can and must be employed in health care. In spite of differences between aviation and health care, the similarities are more striking. Both are intrinsically hazardous endeavors, with complex technology, and dominated by one profession. Both developed a dysfunctional hierarchical culture that substantially increases risk for its customers and patients. Aviation has done something about it: CRM, with dramatic results. Flying is now incredibly safe. The lessons are clear, the cause is urgent, and the time has come for all health care organizations to act accordingly."—Lucian L. Leape, MD, Harvard School of Public Health

"This book is a revelation! Anyone who believes that toxic hierarchies and dangerously ineffective communication are inevitable in health care should think again. Beyond the Checklist heralds a new kind of hospital workplace—one that's already been flight-tested. The dysfunctions of our health care system are tragic and unnecessary, but they can be fixed. This book shows us how."—Theresa Brown, RN, clinical nurse and author of Critical Care

"Beyond the Checklist helps us understand that successfully providing safe and reliable care for our patients requires a multifaceted approach. Mechanisms such as checklists need to be integrated with effective leadership, teamwork, knowledge about human factors, and continuous learning. This book provides valuable insights on a journey that will provide a better care experience for patients, their families, and the people providing care."—Michael W. Leonard, MD, Co-Chief Medical Officer of Pascal Metrics and Adjunct Professor of Medicine at Duke University

"Beyond the Checklist recognizes that it takes more than just the standardized execution of processes to create a culture of safety. As the authors reveal, the team intelligence needed in more hospitals can flourish only in a workplace environment where there is proper training, mutual respect, and real cooperation among coworkers."—Veda Shook, President, Association of Flight Attendants–CWA

"The deeper I progressed into this terrific book, the more embarrassed I became for my profession of medicine. Behind our casual assumption as airline customers that we will arrive safely lies an enormously complex process that addresses all human and system issues that could possibly affect safety in air travel. With a few notable exceptions, we in medicine do not come anywhere remotely close to where we need to be to assure our patients of this same kind of safety commitment. There can be no excuse for medicine not pursuing this same all-engaging, relentless process. Our patients deserve nothing less. This is a must-read book for anyone with any connection at all to the delivery of health care services."—Terry R. Rogers, MD, The Foundation for Health Care Quality

"Beyond the Checklist takes us behind an apparently simple tool to lay out the complex social and organizational transformation that makes the checklist effective in aviation and to argue for a similar top-to-bottom transformation of health care. By shifting our attention to the detailed, sustained, and careful work that will be required to make health care safer, the book moves us forward on a long, difficult, but ultimately rewarding journey."—Robert L. Wears, MD, University of Florida and Imperial College London

"Beyond the Checklist provides a timely and insightful assessment of crew resource management (CRM), a key tool for averting disaster in the airline industry. The authors make a compelling case for its application to health care delivery. This book should become an essential text for health care professionals, educators, and policymakers seeking to improve interprofessional training and practice."—Scott Reeves, University of California, San Francisco

"The ideas presented in this book are so clearly developed and the writing so engaging that its audience will not be limited to patient safety experts. Patients, their families, and health care providers of all kinds will also benefit from the authors' insight into hospital safety improvement. The case studies are rich in detail and full of critical reflections on the connection between quality care and optimally functioning teams. The tone of Beyond the Checklist is hopeful but, for good reason, very urgent as well."—Sean P. Clarke, RN, PhD, FAAN, McGill University School of Nursing

"Some experts downplay the parallels between health care and aviation, but there is much we can learn from the system-wide change that greatly improved passenger safety on commercial airlines. This excellent book highlights the innovative programs of pioneering hospitals where better teamwork and effective communication guide every interaction—from the bedside to the boardroom."—Julia Hallisy, DDS, The Empowered Patient Coalition

"This important book brings both a sense of urgency and the hope of clarity in addressing a fundamental and widespread problem in health care. It is a must-read for clinicians and students who deliver care and a call for leadership from every member of the interprofessional team. Leadership is required to change the culture and systems of care delivery. Beyond the Checklist provides the inspiration and a path for that change."—Heather M. Young, RN, FAAN, Betty Irene Moore School of Nursing, University of California, Davis

"Beyond the Checklist shows us that Crew Resource Management principles help us deal with our human inability to always perform 'perfectly' while operating in a complex work environment. Little mistakes in aviation compound into huge problems. In commercial airlines, virtual strangers routinely solve complex problems without making critical mistakes. The culture of CRM provides for this as a normal way of operation. If embraced by the field of medicine, it will totally transform the way the industry operates."—Captain Gregory S. Novotny

About the Author

Suzanne Gordon is Visiting Professor at the University of Maryland School of Nursing and was program leader of the Robert Wood Johnson–funded Nurse Manager in Action Program. She is the author of Life Support and Nursing against the Odds, coauthor of Beyond the Checklist, From Silence to Voice, and Safety in Numbers, editor of When Chicken Soup Isn't Enough, and coeditor of First, Do Less Harm and The Complexities of Care, all from Cornell.

Patrick Mendenhall is a Principal in Crew Resource Management LLC who is a pilot for a major commercial airline and belongs to the Air Line Pilots Association.

Bonnie Blair O'Connor is Professor of Pediatrics (Clinical) and Associate Director, Pediatric Residency, at Hasbro Children’s Hospital/Alpert Medical School at Brown University in Providence, R.I.

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Customer Reviews

4.7 out of 5 stars
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Great information in this book.
Satisfied Grandma
Group process work, like CRM can be adapted to meet the needs of healthcare systems.
Beth Boynton
A must read, as Gordon tackles the human factor issues in patient safety!
K. Wolf

Most Helpful Customer Reviews

7 of 7 people found the following review helpful By E. Jaksetic on December 26, 2012
Format: Paperback
The aviation industry, in conjunction with aviation regulators, developed a comprehensive system of safety practices and procedures to deal with a broad range of recurring problems that were causing aviation disasters and serious accidents. This book discusses the history of those safety efforts, identifies the critical elements of aviation safety, and argues that health care professionals can learn important lessons that could be applied to significantly reduce medical errors and improve patient safety.

The authors provide an informative look at the history of the development and application of Crew Resource Management (CRM) and threat and error management (TEM) by the aviation industry. They provide a realistic picture of the strengths, weaknesses, and limitations of CRM and TEM, and do not lapse into a simplistic or superficial advocacy of CRM and TEM as panaceas or "quick fixes" for health care professionals trying to reduce medical errors and improve patient safety. Also, the authors are careful to note both similarities and differences between the aviation industry and health care in their discussion, and avoid relying on facile or superficial analogies or comparisons that would undermine their contentions, arguments, and recommendations.

Overall, this book provides an excellent, thoughtful discussion of how the hard-earned lessons of aviation safety can provide insights and ideas that could help reduce medical errors and improve patient safety. Unfortunately, the three case studies about health care institutions used to support the authors' contentions, arguments, and recommendations have an uneven persuasive quality. The first case study provides support for the authors' contentions about the applicability of CRM and TEM to health care.
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3 of 3 people found the following review helpful By Lance Baily on September 10, 2013
Format: Paperback
I can tell you now is a definite MUST-READ for anyone engaging within any avenue of healthcare, education, and/or simulation. This book goes beyond highlighting key examples of the poor communication practices causing systemic failures within healthcare by also providing a direct roadmap to solve these archaic human-made challenges. The authors poignantly remind us that the status quo of healthcare communication can no longer remain "just the way it is".
In Beyond the Checklist, Suzanne Gordon:

1) Diligently lays out the crisis of communication failures occurring within healthcare.
2) Reminds us of the history of similar communication failures within commercial aviation.
3) Demonstrates the 30+ year process of research, program development, and training systems implemented within aviation with regards to communication and team-management.
4) Powerfully explicates "Crew Resource Management" (CRM) as an evolved system for team interactions and operational success.
5) Highlights successful uses of the initial healthcare version of CRM called TEAMSTEPPS.
6) Directs our attention to the unavoidable future of healthcare including regulatory bodies and advanced data-capturing systems.

Most incredibly, Suzanne and her co-authors break down the individual components that make up successful team communication, demonstrates how those pieces are failing within healthcare structures, and provides direct examples of how those issues have already been successfully addressed within aviation.

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3 of 3 people found the following review helpful By The Way I See It on March 10, 2013
Format: Paperback Verified Purchase
I have survived in flying a private plane for many decades... Found out (from this book) a lot about how I can improve my odds of lasting many more decades. I knew commercial pilots years ago who hated the changes that were happening in the airlines with CRM who were like me (old style seat-of-the-pants pilots) and only trusted themselves.They did not want to listen to input from others when decisions were to be made in the plane. They were THE CAPTAIN!

Those of us who survived being "Lone Rangers" of those years got ourselves in and out of trouble several times because we knew we had to do things on our own (macho). If we knew then what we know now, several pilots from years past would still be here instead of augered into terra firma.

This approach is needed in health care because I know nurses who've witnessed many critical errors in surgery, and in prescribing, that could have been avoided if they were allowed to suggest anything to the white coated autocrat. But, sadly, the heirarchy did not allow them to speak up for fear of losing their jobs.

Egos have taken many lives, and it is time for that to end. Gary Null researched the safety of medical care, and wrote "Death By Medicine". He reported that medical care kills almost a million people per year and is the leading cause of death in this country. Many physicians need to become accountable instead of relying on pharmaceutical reps, hospital management, etc. to tell them what to do (and protect them if they make a mistake). An attorney I know will not even do medical malpractice cases because he said "Good luck in getting an MD to testify against another MD." It is not a "transparent" group or organization.

The "standard of care" in medicine is not what should be done in so many cases!
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