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“Contents May Have Shifted”

What can we learn from complex airline systems and procedures?

Gary Gerber, O.D.

“Please be careful when opening the overhead bins, as contents may have shifted during flight.” On every flight, regardless of destination or who the flight attendants are, the words are the same. (As it turns out, my contents have never shifted.) So why is this apparently unnecessary message constantly repeated? And how can literally thousands of employees deliver the same message time after time (while many of us lament that we can't get one staff member to do a simple task, such as answer the phone correctly and consistently)?

First the why: For reasons probably related to common sense and liability, airlines are sticklers for safety and so much so that they feel compelled to teach us acutely obvious tasks, such as how to buckle a seatbelt. Beyond common sense though, their culture is obsessed with safety. So, we sit through the redundant presentations because we've internalized that airlines genuinely believe in safety.

Always the same message

Now the how: How does every flight attendant deliver the same message on every flight? It's no secret that they use checklists and scripts. No surprise there.

Looking at a simple pre-flight safety presentation, you might not be that impressed that it's generated by a checklist.

However, if you consider all the things that go on before getting to that point, it's hard to believe that any flight ever takes off on time or for that matter, takes off at all. Thousands of employees perform hundreds of different jobs in different locations, speaking different languages. They move millions of passengers millions of miles. The aircraft is fueled. Pilots and flight attendants arrive. Baggage loaders (usually) get their jobs done. The “food” is delivered, your seat is (usually) available, the e-ticket kiosk has paper and toner, and on and on the list goes. All focus on ensuring the plane takes off on time and safely. The airline's mile-long list makes ordering a contact lens or entering insurance charges seem easy. Can we realize the same degree of reproducibility found in a complex airline system by mimicking their best practices?

As above, let's start with the “why.” Safety is to airlines as ensuring patients have great vision and healthy eyes is to us. So, when configuring office systems and procedures, focus on what is best for patients, not necessarily what is easiest or best for your practice. If it takes more work via a few extra steps to ensure a patient gets the proper prescription in two fewer days, then that's what you should do. It may seem like it's easier to do a task a certain way, but you need to consider the consequences on patient health, service and courtesy. Avoid shaving a few minutes to claim you are “more efficient.”

Using checklists

How do you ensure reproducibility? Checklists are certainly an option for tasks that have multiple steps, like opening or closing the office. That way, you'll ensure your computer system has been backed up and your alarm activated. For patient-facing tasks, checklists are fine. Except for sight threatening scenarios, it's advised that they are invisible to patients. Achieve this through discreet placement of the script, or in certain cases, memorization via mnemonics and practice.

No doubt the airlines have problems running a customer-friendly and profitable enterprise. Yet, if they can get their thousands of moving gears in synch most of the time, we should able to do the same with our few hundred gears. OM