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Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care
"This book is a tour de force, and no one but John Nance could have written it. He, alone, masters in one mind the fields of aviation, health care safety, medical malpractice law, organizational sociology, media communication, and, as if that were not enough, the art of fine writing. Only he could have made sophisticated, scientifically disciplined instruction about the nature and roots of safety into a page-turner. Medical care has a ton yet to learn from the decades of progress that have brought aviation to unprecedented levels of safety, and, in instructing us all about those lessons, John Nance is not just a bridge-builder - he is the bridge. This book should be required reading for anyone willing to face the facts about what it will take for health care to be as safe as it truly can be." Donald M. Berwick, MD, MPP President and CEO Institute for Healthcare Improvement (IHI)
267 pages, Kindle Edition
First published January 1, 2008
116 people are currently reading
596 people want to read
About the author
John J. Nance
66 books227 followersJohn J. Nance is an American pilot, aviation safety expert, and author. He served in the USAF during the Vietnam War and also as a Lt. Colonel in Operation Desert Storm.
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Displaying 1 - 30 of 51 reviews
May 21, 2013
Greatly oversimplifies the problem. A lawyer, posing as a doctor, preaching how to increase patient safety. Gives the impression that if doctors just let nurses be in charge, the problem would be solved. Which may be true for many things, but not the only answer. Good examples through aviation's focus on safety, but overall doesn't offer many solid, concrete ways to solve the problems of patient safety in practical manners. The main premise of the book is the necessity of a cultural change, which in my limited experience has largely spread through health care. While there is always room for improvement, I think very few doctors think they still live in some "good ol' boys club" where not treating everyone with respect is tolerated. While this is an absolutely necessary and valid step, it does not convert to some utopia the book creates of St. Michael's hospital.
July 4, 2019
This was on my professional TBR list for sometime and as a medication safety pharmacist, it was interesting. However, I find myself continually frustrated by the non-fiction book that is set-up using a fictionalized account - in this case, Dr. Will Jenkins visits St Michael’s Hospital to find out how they have instituted sweeping patient safety reforms.
Why does the author, a lawyer with a background in aviation safety, use a fictional account to describe needed patient safety reforms? Because no one place does it all. As he states, hospitals need an overhaul in their processes and procedures, but unlike the aviation industry, they can’t ground the places while they retrofit a plane or retrain crews on a system. Healthcare needs to be reformed ‘on the fly’, so to speak. Some hospitals do some or much of this - but no one does all of it. I may take nothing less than a total mindset change - as the author states, shifting healthcare from an industry to a public utility.
Information to remember:
...human factor mistakes increase when people are in a hurry.
...when it involves safety and protection from human error, an individual, no matter how professional and experienced, can never be anywhere near as reliable as a group can be. They’ve also given us tragic evidence that a group divided against itself by professional jealousy, stratification, or just inability to communicate, is doomed to fail....But if you get people to respect and interact respectfully with one another for the common goal of helping the patient, the culture can and will change. Fail to do that, and you can bring in all the tactical methodologies you want, and in the end they’ll amount to nothing.
We work hard to do two things: Institutionalize and standardize those procedures that we know work best, and reduce variables in practice and response when those variables do nothing to contribute to the quality of decision-making of physicians and nurses.
Remember, if it can be misread, misunderstood, misinterpreted, misquantified, or just plain missed, it will be. The way to guarantee that mistakes won’t hurt our patients is to always assume the worst, expect mistakes, and use without variance the systems we’ve designed specifically to neutralize such errors.
Why does the author, a lawyer with a background in aviation safety, use a fictional account to describe needed patient safety reforms? Because no one place does it all. As he states, hospitals need an overhaul in their processes and procedures, but unlike the aviation industry, they can’t ground the places while they retrofit a plane or retrain crews on a system. Healthcare needs to be reformed ‘on the fly’, so to speak. Some hospitals do some or much of this - but no one does all of it. I may take nothing less than a total mindset change - as the author states, shifting healthcare from an industry to a public utility.
Information to remember:
...human factor mistakes increase when people are in a hurry.
...when it involves safety and protection from human error, an individual, no matter how professional and experienced, can never be anywhere near as reliable as a group can be. They’ve also given us tragic evidence that a group divided against itself by professional jealousy, stratification, or just inability to communicate, is doomed to fail....But if you get people to respect and interact respectfully with one another for the common goal of helping the patient, the culture can and will change. Fail to do that, and you can bring in all the tactical methodologies you want, and in the end they’ll amount to nothing.
We work hard to do two things: Institutionalize and standardize those procedures that we know work best, and reduce variables in practice and response when those variables do nothing to contribute to the quality of decision-making of physicians and nurses.
Remember, if it can be misread, misunderstood, misinterpreted, misquantified, or just plain missed, it will be. The way to guarantee that mistakes won’t hurt our patients is to always assume the worst, expect mistakes, and use without variance the systems we’ve designed specifically to neutralize such errors.
April 25, 2015
I desperately wanted to like this book. I love and have studied aviation, I work in healthcare administration, there are such obvious comparisons between the two industries. Healthcare is slowly being dragged kicking and screaming toward the standard practices and culture of aviation... I thought I would love this book. Instead I found it remarkably condescending and repetitive. I suppose there are definitely healthcare administrators I know who probably need something as slow and simplified as this to just slowly beat them over the head with, but for me this was painful and I never finished it.
February 4, 2018
Interesting concept. Would love to see more of these HP concepts in hospitals.
January 16, 2018
Certainly there are plenty of issues with this book: it seems unrealistic, it seems a bit pollyana in its ability to take one hospital and change the entire healthcare industry, in terms of patient safety.
But Nance addresses real issues in healthcare: doctors who don't make changes because they don't work directly for the hospitals, toxic relationships between physicians and nursing staff, the inability of providers, particularly surgeons, to respond well to criticism, etc.
Certainly, this book isn't going to be an end-all solution, but it does present an interesting perspective: if we treat every patient injury or death the way that we treat plane crashes (including near misses), then maybe we'd start to develop systems that allow a culture of safety to grow in hospitals and medical clinics. Nance clearly states that this isn't a recipe book in his epilogue, but it certainly does open up a lot of areas for discussion regarding wasted nursing resources, creating collaborative teams, opportunities for patient advocacy from the entire team, and so on.
As long as we continue to view healthcare as a business or industry, rather than a public utility, it will continue to only change at the speed of money, and investing in patient safety and positive hospital culture is expensive on the front end with costs recouped slowly over time. Most hospitals, particularly rural ones, can't afford those initial costs. But the cost to patient trust in the health care system is the price we're paying, and justly so.
This book presents a fairly (perhaps overly) simple look at a possible way to change hospital culture from the ground up, rather than the top down, in favor of patient safety. And isn't that worth considering?
But Nance addresses real issues in healthcare: doctors who don't make changes because they don't work directly for the hospitals, toxic relationships between physicians and nursing staff, the inability of providers, particularly surgeons, to respond well to criticism, etc.
Certainly, this book isn't going to be an end-all solution, but it does present an interesting perspective: if we treat every patient injury or death the way that we treat plane crashes (including near misses), then maybe we'd start to develop systems that allow a culture of safety to grow in hospitals and medical clinics. Nance clearly states that this isn't a recipe book in his epilogue, but it certainly does open up a lot of areas for discussion regarding wasted nursing resources, creating collaborative teams, opportunities for patient advocacy from the entire team, and so on.
As long as we continue to view healthcare as a business or industry, rather than a public utility, it will continue to only change at the speed of money, and investing in patient safety and positive hospital culture is expensive on the front end with costs recouped slowly over time. Most hospitals, particularly rural ones, can't afford those initial costs. But the cost to patient trust in the health care system is the price we're paying, and justly so.
This book presents a fairly (perhaps overly) simple look at a possible way to change hospital culture from the ground up, rather than the top down, in favor of patient safety. And isn't that worth considering?
June 14, 2012
This is such an eye opening book for patients and healthcare workers. The airline industry is very stringent in the safety of their travelers. The author describes how hospitals could learn from the airline industry. However, many healthcare workers will wonder how they could possibly do this due to the many interruptions and when staffing is thin. Read and see what you think.
July 23, 2020
I read this about 10 years ago when it was first published, then decided to read it again recently to see if I got anything different from it this time around, having been immersed for another 10 years in a community hospital.
Definitely got more from it this time!
Especially since a few days I had to deal with a wrong medication being given to a patient. Patient safety is still a huge issue in a super-complex system with ever-moving parts.
There were a number of key concepts that I thought were fundamental to improving safety:
1. Human beings are going to make mistakes regardless of training, experience, or determination. That's just a fact of life.
2. Minimize human error through training and cultural change.
3. Build a work environment where your mistakes can be caught by a) other people (nurses, pharmacists, janitors, portering staff, dieticians etc or b) back-up systems to absorb the error before patients are affected.
4. Despite building the things in 3. -- expect that EVERYTHING YOU DO still has a 50:50 chance of being wrong. Anticipate being wrong.
5. When something does go wrong -- forget trying to find a root cause. There is no such thing. There will be many root causes. Find and fix the systemic issues that contributed to the problems.
6. Behind every disaster there is a Tragically Flawed Assumption. To be honest this just manifested in my personal life too -- no disaster, but a heated argument with a family member due to a flawed assumption that was not articulated. Watch for errors in PERCEPTION, ASSUMPTION, and COMMUNICATION.
7. Get rid of the antiquated idea that humans can multi-task. If you're a human, you can't multi-task. You can sequentially-task, which means you can do back-and-forth serial processing but not parallel processing. Once this ability is saturated, all the balls you have in the air will fall down and you will have to start from zero.
8. and many more very cool concepts...and presented in a very engaging manner.
Highly recommended for any Health care worker who is interested in the well-being of their patients.
Definitely got more from it this time!
Especially since a few days I had to deal with a wrong medication being given to a patient. Patient safety is still a huge issue in a super-complex system with ever-moving parts.
There were a number of key concepts that I thought were fundamental to improving safety:
1. Human beings are going to make mistakes regardless of training, experience, or determination. That's just a fact of life.
2. Minimize human error through training and cultural change.
3. Build a work environment where your mistakes can be caught by a) other people (nurses, pharmacists, janitors, portering staff, dieticians etc or b) back-up systems to absorb the error before patients are affected.
4. Despite building the things in 3. -- expect that EVERYTHING YOU DO still has a 50:50 chance of being wrong. Anticipate being wrong.
5. When something does go wrong -- forget trying to find a root cause. There is no such thing. There will be many root causes. Find and fix the systemic issues that contributed to the problems.
6. Behind every disaster there is a Tragically Flawed Assumption. To be honest this just manifested in my personal life too -- no disaster, but a heated argument with a family member due to a flawed assumption that was not articulated. Watch for errors in PERCEPTION, ASSUMPTION, and COMMUNICATION.
7. Get rid of the antiquated idea that humans can multi-task. If you're a human, you can't multi-task. You can sequentially-task, which means you can do back-and-forth serial processing but not parallel processing. Once this ability is saturated, all the balls you have in the air will fall down and you will have to start from zero.
8. and many more very cool concepts...and presented in a very engaging manner.
Highly recommended for any Health care worker who is interested in the well-being of their patients.
May 7, 2020
Honestly hated this book. I’m disappointed because I’ve heard from a few people that this book was worth while...but It was so hard to get through. First of all, the style of the book being written like a novel but discussing patient safety was so dry and felt fake as heck. It took like 3 pages of fake discussion to cover a topic that could be said in more than half the space. Also it was super unrealistic and you could definitely tell that it was a lawyer writing this book and not anybody in the medical field, because a lot of things that his utopian hospital mentioned would not be possible in the real world. And whenever opposition was mentioned in the book it would be brushed off with very little explanation. It was especially hard because the hospital as a whole is fake, so none of this actually happened and isn’t proven to work in real life. On the positive side, I did come up with a handful of good tidbits of things to incorporate into my own patient care to improve the safety of my patients....but they were few and far between.
November 8, 2019
somewhere between a corporate compliance vignette and an actual novel, the book does effectively discuss patient safety issues and the challenges of culture change, though many of the interventions and practices in this fictional hospital strike me as unrealistic to the point of unhelpfulness. a particular passage that revealed the out-of-touch nature of some of the advice went "and then implementing the electronic health record made things even easier!" said no one ever.
February 26, 2022
I’d love to work at this imaginary hospital. Sign me up!
However, some of what is suggested would risk increasing harm. Specifically, changing protocols based on a single event may introduce new errors that could be avoided by a more complete review.
This may be too simplistic. It is a good book if your haven’t already imagined safer health care. Average if this passion already burns hot in your belly.
However, some of what is suggested would risk increasing harm. Specifically, changing protocols based on a single event may introduce new errors that could be avoided by a more complete review.
This may be too simplistic. It is a good book if your haven’t already imagined safer health care. Average if this passion already burns hot in your belly.
November 30, 2022
A great insight on the healthcare system and a possible solution to change the culture within that system. My frustrations come from the repetitive narrative by using fictionalized scenarios and characters sprinkled in with real life consequences. Enjoyable read but changing the way a hospital is operated is easier said than done.
June 6, 2018
This his not a fictional novel, but if you chose to read the material you will not be disappointed. Air Rescue, Air Evacs and Para-Rescuers are discussed in detail and as you read the material you will ion learn how important Air Flight can be in emergencies. This is an excellent read for the genre.....DEHS
July 28, 2023
Interesting comparison of industries and helpful perspective on culture needed for safety in health care. Challenging to implement in large organizations, but definitely worth a read to help with direction.
July 4, 2018
A Classic of modern healthcare
Should replace or at least augment House of God as required reading more than once in each health professional’s career.
Should replace or at least augment House of God as required reading more than once in each health professional’s career.
June 25, 2019
If only... I think my current workplace would need a complete overhaul to achieve this level of transparency. If every healthcare worker read this, we'd be in a much better spot
July 20, 2025
Wow! Absolutely fantastic book and wish it t was practiced in all hospitals!
September 2, 2025
Good concepts, but pretty repetitive and unrealistic.
September 8, 2025
snooze-fest. i think i learned more about airplane crashes than i did health care💀
April 30, 2010
I have enjoyed many of John Nance’s novels so, while recently exploring the web for new releases, I was surprised to come across his title Why Hospitals Should Fly. Curious, I checked out Amazon for their critique and became even more intrigued.
The timing of this occurred during the final stages of the Health Care Reform debate. The interface of this book’s subject matter, with all that highly charged emotional and often times irrational behavior, prompted my desire to understand John’s position on health care safety, etc. Especially given his novel was voted 2009 Book of the Year by the American College of Healthcare Executives.
It amazes me when you hear statistics such as a minimum of 10% of all patients admitted to hospitals are further injured by things going wrong with their care. Or the fact that at least 100,000 patients die each year from just hospital acquired infections alone. A staggering result of a system that, from the outside, appears out of control. What other industry or company in this country would be tolerated with that kind of incident rate without some form of forced intervention? John’s perspective and suggested remedies are interesting, have been proven to work, but come with very difficult and provocative culture changes.
Interesting and very pertinent subject matter that John has addressed in this fictionalized story. I believe it ranks 5 from that stand point. But the story line and delivery left me flat. Half way through the book I found myself skipping ahead in sections and then fully reading the summaries at the end of each chapter. A rating of 2 to 3 at this level. Overall, a 4 due to the importance of the message.
The timing of this occurred during the final stages of the Health Care Reform debate. The interface of this book’s subject matter, with all that highly charged emotional and often times irrational behavior, prompted my desire to understand John’s position on health care safety, etc. Especially given his novel was voted 2009 Book of the Year by the American College of Healthcare Executives.
It amazes me when you hear statistics such as a minimum of 10% of all patients admitted to hospitals are further injured by things going wrong with their care. Or the fact that at least 100,000 patients die each year from just hospital acquired infections alone. A staggering result of a system that, from the outside, appears out of control. What other industry or company in this country would be tolerated with that kind of incident rate without some form of forced intervention? John’s perspective and suggested remedies are interesting, have been proven to work, but come with very difficult and provocative culture changes.
Interesting and very pertinent subject matter that John has addressed in this fictionalized story. I believe it ranks 5 from that stand point. But the story line and delivery left me flat. Half way through the book I found myself skipping ahead in sections and then fully reading the summaries at the end of each chapter. A rating of 2 to 3 at this level. Overall, a 4 due to the importance of the message.
June 30, 2016
Some very good ideas about culture change that can strongly benefit healthcare. Nance uses analogies to effectively break down assumption and mental barriers which often preclude innovation. It's accessible to the lay person as well as those in healthcare professions.
However, I found the fictional framework distracting and his conclusions overly optimistic. The safety issues in hospitals will not be solved with a culture change alone. I also found a few real life incidents and persons he mentions exaggerated and overly praised (I'm familiar with some of them) which casts a mild shadow on aspects of his enthusiasm. I'd have preferred a more professionally written book by someone who didn't appear quite so eager to drink the cool-aid.
That said, there are interesting concepts and problem solving strategies in this book. It's a worthwhile read.
However, I found the fictional framework distracting and his conclusions overly optimistic. The safety issues in hospitals will not be solved with a culture change alone. I also found a few real life incidents and persons he mentions exaggerated and overly praised (I'm familiar with some of them) which casts a mild shadow on aspects of his enthusiasm. I'd have preferred a more professionally written book by someone who didn't appear quite so eager to drink the cool-aid.
That said, there are interesting concepts and problem solving strategies in this book. It's a worthwhile read.
October 5, 2016
Good, not great. Nance is a great writer, however the framework was a bit too fictional and unrealistic. Cultural change is critical and for sure takes time. Typically you claim success when a few milestones are met but adopting the changes take a very long time. The uber-praise and the intolerance for anyone not immediately signing on was a bit much.
More than cultural change is needed, for sure. The book would have benefited from a nurse or someone NOT a doctor making a decision that was wrong and a realistic assessment and protocol change being introduced and inculcated.
Overall, I found the objective of the book healthy and well presented. I would have preferred a clinical/administrative/outsiders perspective that was professional rather than a "do this, believe this and all will be well" framework.
More than cultural change is needed, for sure. The book would have benefited from a nurse or someone NOT a doctor making a decision that was wrong and a realistic assessment and protocol change being introduced and inculcated.
Overall, I found the objective of the book healthy and well presented. I would have preferred a clinical/administrative/outsiders perspective that was professional rather than a "do this, believe this and all will be well" framework.
January 12, 2011
This is an excellent book. I hope to get a copy on my bookshelf someday so that I can have the ability to re-read sections on days when I need insight.
If you are in medicine, engineering, quality assurance, academics, research-driven science, or any related field, you should feel compelled to read this book. Nance considers the airline industry and it's safety and quality evolution in the 1970's, and applies the same principles to our broken health care delivery system.
There was one chapter in Dr. Atul Gawande's book Better that parallels the principles of this novel. Still, the advantage goes to "Why Hospitals Should Fly," because it tackles the issues through a captivating story.
If you are in medicine, engineering, quality assurance, academics, research-driven science, or any related field, you should feel compelled to read this book. Nance considers the airline industry and it's safety and quality evolution in the 1970's, and applies the same principles to our broken health care delivery system.
There was one chapter in Dr. Atul Gawande's book Better that parallels the principles of this novel. Still, the advantage goes to "Why Hospitals Should Fly," because it tackles the issues through a captivating story.
June 19, 2015
I would recommend this for any sort of workplace. There are wonderful lessons to be learned by using the stories and lessons as a method of self-reflection. If I could distill this book into a single word, that word would be "respect". Learn to respect every persons contributions and perspectives. No, I'm not saying that every perspective is right or wrong. This book helped reinforce the fact that every person brings with them their own unique value of perspective and one of our goals should be to not let our own personal title, salary, position, ego, etc. get in the way of listening and respecting them.
July 22, 2015
Very creative fictional narrative on how a hospital should adopt aviation protocols. Dr Will visits St Michael's in Denver and meets with the CEO Jack Silverman. He learns a great deal from Jack and his staff, tours the hospital and sees the culture, sits in on an orientation, rounds, etc. Although it's fictional, it gives one a good idea of cultural change in action. I've read a number of books on this topic and I do respect HRO and aviation as a great model to transform healthcare. Lots of notes and lessons to take away. If you're concerned about quality and safety or sitting on a Quality Committee, it's a must read. I'll be reading the sequel next.
May 26, 2014
Emphasis on teamwork which I believe depends on communication and trust. Nicely uses examples from aviation to illustrate breakdowns in communication and teamwork. Fair amount on crew resource management (basic teamwork under situations of dynamic stress). Emphasis on ideas from FMEA - anticipate failures then redesign the system to reduce their frequency, diminish their impact and recognize them before they cause catastrophe. Was pleased to see that one of the "over the top" changes was recording surgical procedures.
August 25, 2014
A great look into the state of hospitals, and one person's view on how to change the way hospitals operate. The author cited numerous examples of airplane failures and steps to change the aviation culture (which took a lot of time) and how those same lessons can be applied to the hospital setting.
This was a fairly fast read and did not get bogged down into details. Some of those details are probably vitally important, and who knows if they would work, but the book does bring about the some good changes to the culture of medicine. I am glad I took the time to read it.
This was a fairly fast read and did not get bogged down into details. Some of those details are probably vitally important, and who knows if they would work, but the book does bring about the some good changes to the culture of medicine. I am glad I took the time to read it.
June 26, 2016
Not involved in either the airline or hospital industries but having experience as a consumer of both, I found the book interesting. Last summer, for example, I had interventional radiology procedures that were very routine and successful, but I had a horrible experience because of three strains of bacteria. The "young" doctor apparently forgot to prescribe antibiotics, so I am at home feeling very sick for weeks infusing myself with IV equipment and materials.
The example of an outstanding hospital and comparisons to commercial aviation practices was very interesting and edifying.
The example of an outstanding hospital and comparisons to commercial aviation practices was very interesting and edifying.
September 25, 2011
I enjoyed this book. Even though the hospital that it talks about is fictional, it presents a lot of really good ideas and philosophies that I think hospitals are missing. I wonder how many of hte administrators that I work wiht have read it and what they think about it. I wish that I worked in an environment where communication and belief in each other were as impressive as in this fictional hospital.
July 13, 2014
This book discusses an ideal (fictional) hospital leading in patient safety and quality care. I am hoping my new job at Duke Hospitals will be something like this! I have seen how dangerous and demoralizing it can be when nurses are overworked, understaffed, and lacking the proper resources. I haven't yet experienced abusive behaviors from doctors, but I haven't had much need to interact with them yet. Hopefully attitudes have changed!
Displaying 1 - 30 of 51 reviews