Not like too many hospitals

#TPSER9 I write this after leaving the residents' and students' education programs in Telluride as I await the delayed departure of my Southwestern Airlines flight out of Denver airport.  It is delayed because there is a malfunctioning windshield wiper, and the mechanic (above) has been making repairs. We need to understand that this windshield wiper, on the co-pilot's side, is not likely to be needed while the plane is in flight as the airspeed cleans the windshield, or even on the ground taxiing, as it might not be raining. Nonetheless, quite appropriately, the flight will not commence--and passengers will not be loaded--until or unless it is fixed.

Let's contrast this with the procedures, or lack of procedures, followed in many hospitals.  How many times have surgeries begun without a proper time-out to ensure that all necessary supplies and equipment are at hand and in working order?  The lack of compliance with pre-surgical checklists is rampant throughout the world.  Sometimes this is from a lack of training.  Sometimes it is because an impatient surgeon starts a case in violation of the protocol, and his/her OR team is too intimidated to mention the issue.  (Remember this episode from the TV show ER? An associated story here.)

As I have said before:

Sometimes, I remind myself to be patient.  It is hard to change the medical system quickly.  But, more often,  I find myself agreeing with the words of Captain Sullenberger:

"I wish we were less patient. We are choosing every day we go to work how many lives should be lost in this country. We have islands of excellence in a sea of systemic failures. We need to teach all practitioners the science of safety."

I hope and trust that our attendees these last few days in Telluride will have the commitment and courage to make a difference during their careers.