Safety Matters
Ed MacDonald
Complacency, Competition, and Credibility I imagine it would be very difficult to find any manager— be it a program director, chief pilot, maintenance lead, chief communications specialist, or other air medical leader—who would ascribe to any action that would put their program or operations at risk. With that being said, it is altogether too easy to let the day-to-day alligators in the swamp divert us from what is really important. Far too often in over 40 years in this avocation have I seen well-meaning leaders verbalize their commitment to safety yet fail to really demonstrate by their actions, not words, where their real priorities lie. Complacency comes into play when a manager “assumes” that the safety programs and processes are really functioning—not just paper and fluff. Are those programs really identifying the risks and hazards that will put our program and, most of all, our people in harm’s way? Far too often when I ask managers about their safety program, they haul out documents, posters, and minutes of meetings, and, on the surface, it looks like all is in place. The documents, posters, and minutes usually satisfy a very shallow external or internal audit but often do not really get down to the cultural issues that are at the real root cause of potential tragedies in our industry. All of the trappings of a safety program are in place, but nobody is really asking the hard questions for a myriad of reasons including simple complacency. We must be in the habit of boring down to find those gremlins that will cause us great harm. It is not laziness but simply making assumptions that all is well or, even more insidious, not wishing to know the real truth. In my opinion, complacency is a root cause or contributing factor in far more incidents and accidents than discovered by the past National Transportation Safety Board reports. In the past, the National Transportation Safety Board and Federal Aviation Administration have often failed to get into the real root causes and underlying organizational culture in their reports; therefore, cultural issues are grossly underreported. Granted, they are hard to uncover during a 3-day visit to a program after an accident, but if we really want to know “why,” they cannot be overlooked. Complacency comes when we see a problem and walk right by it. It comes when we push that known issue into some future date to be resolved. It comes when we think that someone else will deal with it. When ignored, it will bite us where we sit. “Facts do not cease to exist because they are ignored.” Aldous Huxley, Complete Essays 2, 1926-1929 Competition is one of the things that has made this country a great and innovative power. From supercomputers to sophisticated aircraft to shiny new cars, competition makes each subsequent model better than the last one. It drives 136
innovation and product improvement and improves service and customer satisfaction. No one would deny that good competition has driven many companies, products, and services to incredible growth and capabilities. It has taken our air medical industry to great heights and given us incredible new aircraft, drugs, equipment, safety features, communications, tools, and processes envied and copied throughout the world. Doing battle in the marketing arena with the neighboring program or operator is generally healthy unless the competitive spirit creeps into those things that we know create higher risk. Competing with launch times or questioning a pilot’s professional decision making can have adverse consequences and push flight crews and pilots into harm’s way with no real competitive value. One accident caused by undue pressure to fly, either internal or through competitive pressure, is but one tragic consequence. Air medical managers who are new, overzealous, or unenlightened about the consequences of undue pressure to fly can inadvertently create pressures on timid flight crewmembers to take flights that their professional decision making would reject. Pressure to beat the competition, create more business, or even save the program by increasing volume can put pressures on both experienced and novice flight team members. This pressure need not come from external forces such as competition but can also be found within each team member trying to excel above and beyond their peers or show team spirit. “Gung ho” can be a real asset on the football field or boot camp, but, sometimes, in our avocation, it may lead to hasty or risky decision making. The best way to “beat” the competition is not through pushing crews to make risky decisions or playing the hurryup game but through solid professional customer-oriented safe and efficient service. Credibility is tied closely to believability and integrity in my opinion. This is where “actions speak louder than words” In our business, if a manager starts out every meeting with well-meaning slogans like “safety is job one” or “safety first” and then spends the other 99% of the meeting talking about everything but safety, then perhaps that safety message gets lost. If the slogans are the preamble yet the body of the message is about ‘improving our launch times,” the bottom line, or marketing, then perhaps the mixed message is more about dollars than real safety. The hard questions need to be asked, and program team members must feel that the real risks are identified and acted upon. The culture must be one wherein all can speak freely rather than yes men and women pursuing only the bottom line. It must be a just culture in which all team members can feel free to point out the risks and admit their mistakes as well as put forth suggestions openly. When it comes to the bottom line, it is about doing our noble work Air Medical Journal 33:4
and always coming home in one piece. The only bottom line that really counts is making a difference in the lives of those we serve and those we come home to.
of the AAMS Safety Committee, and a major in the US Army Medical Service Corps, retired. He can be reached at [email protected].
Ed MacDonald is an EMS pilot for San Antonio AirLIFE, past chairman of the Air Medical Safety Advisory Council, past president of the National EMS Pilots Association, past co-chair
1067-9991X/$36.00 Copyright 2014 by Air Medical Journal Associates http://dx.doi.org/10.1016/j.amj.2014.04.007
Erratum Figure 2 in the article “A 47-Year-Old Woman With an Intracerebral Hemorrhage” (May-June 2014, page 90) should have included the statement “© Medtronic Inc.”
July-August 2014
137
Ed MacDonald
Complacency, Competition, and Credibility I imagine it would be very difficult to find any manager— be it a program director, chief pilot, maintenance lead, chief communications specialist, or other air medical leader—who would ascribe to any action that would put their program or operations at risk. With that being said, it is altogether too easy to let the day-to-day alligators in the swamp divert us from what is really important. Far too often in over 40 years in this avocation have I seen well-meaning leaders verbalize their commitment to safety yet fail to really demonstrate by their actions, not words, where their real priorities lie. Complacency comes into play when a manager “assumes” that the safety programs and processes are really functioning—not just paper and fluff. Are those programs really identifying the risks and hazards that will put our program and, most of all, our people in harm’s way? Far too often when I ask managers about their safety program, they haul out documents, posters, and minutes of meetings, and, on the surface, it looks like all is in place. The documents, posters, and minutes usually satisfy a very shallow external or internal audit but often do not really get down to the cultural issues that are at the real root cause of potential tragedies in our industry. All of the trappings of a safety program are in place, but nobody is really asking the hard questions for a myriad of reasons including simple complacency. We must be in the habit of boring down to find those gremlins that will cause us great harm. It is not laziness but simply making assumptions that all is well or, even more insidious, not wishing to know the real truth. In my opinion, complacency is a root cause or contributing factor in far more incidents and accidents than discovered by the past National Transportation Safety Board reports. In the past, the National Transportation Safety Board and Federal Aviation Administration have often failed to get into the real root causes and underlying organizational culture in their reports; therefore, cultural issues are grossly underreported. Granted, they are hard to uncover during a 3-day visit to a program after an accident, but if we really want to know “why,” they cannot be overlooked. Complacency comes when we see a problem and walk right by it. It comes when we push that known issue into some future date to be resolved. It comes when we think that someone else will deal with it. When ignored, it will bite us where we sit. “Facts do not cease to exist because they are ignored.” Aldous Huxley, Complete Essays 2, 1926-1929 Competition is one of the things that has made this country a great and innovative power. From supercomputers to sophisticated aircraft to shiny new cars, competition makes each subsequent model better than the last one. It drives 136
innovation and product improvement and improves service and customer satisfaction. No one would deny that good competition has driven many companies, products, and services to incredible growth and capabilities. It has taken our air medical industry to great heights and given us incredible new aircraft, drugs, equipment, safety features, communications, tools, and processes envied and copied throughout the world. Doing battle in the marketing arena with the neighboring program or operator is generally healthy unless the competitive spirit creeps into those things that we know create higher risk. Competing with launch times or questioning a pilot’s professional decision making can have adverse consequences and push flight crews and pilots into harm’s way with no real competitive value. One accident caused by undue pressure to fly, either internal or through competitive pressure, is but one tragic consequence. Air medical managers who are new, overzealous, or unenlightened about the consequences of undue pressure to fly can inadvertently create pressures on timid flight crewmembers to take flights that their professional decision making would reject. Pressure to beat the competition, create more business, or even save the program by increasing volume can put pressures on both experienced and novice flight team members. This pressure need not come from external forces such as competition but can also be found within each team member trying to excel above and beyond their peers or show team spirit. “Gung ho” can be a real asset on the football field or boot camp, but, sometimes, in our avocation, it may lead to hasty or risky decision making. The best way to “beat” the competition is not through pushing crews to make risky decisions or playing the hurryup game but through solid professional customer-oriented safe and efficient service. Credibility is tied closely to believability and integrity in my opinion. This is where “actions speak louder than words” In our business, if a manager starts out every meeting with well-meaning slogans like “safety is job one” or “safety first” and then spends the other 99% of the meeting talking about everything but safety, then perhaps that safety message gets lost. If the slogans are the preamble yet the body of the message is about ‘improving our launch times,” the bottom line, or marketing, then perhaps the mixed message is more about dollars than real safety. The hard questions need to be asked, and program team members must feel that the real risks are identified and acted upon. The culture must be one wherein all can speak freely rather than yes men and women pursuing only the bottom line. It must be a just culture in which all team members can feel free to point out the risks and admit their mistakes as well as put forth suggestions openly. When it comes to the bottom line, it is about doing our noble work Air Medical Journal 33:4
and always coming home in one piece. The only bottom line that really counts is making a difference in the lives of those we serve and those we come home to.
of the AAMS Safety Committee, and a major in the US Army Medical Service Corps, retired. He can be reached at [email protected].
Ed MacDonald is an EMS pilot for San Antonio AirLIFE, past chairman of the Air Medical Safety Advisory Council, past president of the National EMS Pilots Association, past co-chair
1067-9991X/$36.00 Copyright 2014 by Air Medical Journal Associates http://dx.doi.org/10.1016/j.amj.2014.04.007
Erratum Figure 2 in the article “A 47-Year-Old Woman With an Intracerebral Hemorrhage” (May-June 2014, page 90) should have included the statement “© Medtronic Inc.”
July-August 2014
137
