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Safety at the top

JULY 29, 2020

“One error is one too many.”

“Not on my watch.”

How many times have we heard that?   How many times have we made those statements?  

Safety cannot be delegated.  It is everyone’s responsibility; however, it starts at the top.  A robust safety system requires leaders to be catalysts for continuous improvement. When two diverse and complex organizations such as an aviation provider and its healthcare partners work together, it is imperative to organize performance and share one single priority – safety.  In all aspects of the mission, we have no choice but to function reliably 100% of the time.  If reliability is compromised, the desired outcome will be also.

In the 1960s, Dr. Avedis Donabedian coined “Structure + Process = Outcomes.”  Designed to evaluate quality of care, this framework can also be applied to safety. To achieve desired outcomes, we must establish structure and process and execute those on each and every mission and patient encounter.  Let’s take this a step further and add culture to the equation: Culture + Structure + Process = Outcomes.

Safety expectations should be built into ALL organizational roles.  All mindsets should be engaged with cross-cultural competencies in place. Leaders of the organization and the transport program set the stage, create and communicate expectations, and maintain a just culture of accountability. 


Leaders should create mindfulness to avoid blind spots and manage the unexpected threat

  • The first principle in High Reliability is Preoccupation with Failure. Historically, our industry engages in annual or quarterly safety stand-downs.  While this may be a great tactic, is it enough?  Mindfulness evolves, is ongoing, and is different than situational awareness.  Mindfulness is about the quality of attention given 100% of the time. Consider the quality of debriefs after each mission and huddles at the beginning of each shift. Do leaders give quality attention and oversight to these established structures and processes? Is the information and data documented during these huddles and debriefs reviewed, quantified, and shared with you, as leaders?  If so, what immediate actions are taken to avoid a build-up of blind spots that conceal small issues?
  • As quoted in the book Managing the Unexpected, “Data science only matters if the data drives actions. Common fallacies are data is opposed to intuition.  Data is a tool for enhancing intuition.” In other words, mindfulness can avoid blind spots and the unexpected threat can be managed. 


Create and communicate expectations in every verbal and written forum.

  • Effective communication is an art with a foundation of active listening. As leaders, it is imperative to not just hear, but process the information and respond accordingly to elicit actions.  There should be no gray areas when it comes to safety expectations of the entire team. Distractions are rampant and outside forces of legislation, regulation, and market activity influence and potentially undermine safe operations.  To stay vigilant in safety, it should be the top agenda item and top function in daily operations, ranging from formal and informal meetings to walking rounds with a purpose, regardless of distractions and noise levels.  While that sounds simple, when leading multi-disciplinary teams in a cooperative relationship, difficulties will arise. If difficulties do arise, mindful leaders should fact-check motives and then have any necessary crucial conversations.  The bottom line is to continually keep an open door to promote a healthy culture for two-way communication.


Advance the safety agenda with accountability that starts with leaders.

  • A culture of accountability and flexibility promotes resilient performance; however, it requires leaders to mind any potential gaps in performance. How do leaders mind the gap?  Keep a compelling scorecard of qualitative and quantitative data that is simple and visible to all team members.  The scorecard should tell a story and the team should be able to determine if safety is top priority and progress is being made. If progress is not being made, leaders should be curious and re-evaluate structures and processes to gain the desired outcomes. 

Maintaining and enhancing safe and excellent operations takes a village with influential, and at times, directive leadership. 

One may suggest that a robust safety system is an intangible asset because the cost is hard to quantify.  However, the cost is easily quantifiable when there is a less than a desirable outcome; therefore, making the value of safety priceless.  As leaders, our daily habits and practices set the stage and culture to prioritize a safe and solid infrastructure.

ADM to Traditional

Check out our case study on an air medical program that went from an Alternative Delivery Model (ADM) to Traditional in a matter of months.