• Patient Safety Starts with an Aligned Crew

    An interview with Captain Chesley B. “Sully” Sullenberger III Nov 06, 2013

    An aviation hero shares some take-aways with physicians on creating strong, safety-focused patient care teams. 

    Sully Sullenberger

    Like many clinical teams that assemble to care for patients, airline crews often bring together complete strangers. In fact, Captain Chesley B. “Sully” Sullenberger only met Jeff Skiles, the co-pilot of fated U.S. Airways Flight 1549, three days before the icy river landing that earned Sully the nickname “Hero of the Hudson.” 

    “Yet, had you been in our cockpit, you would have thought that we’d been working together for years. We were a team,” said Sullenberger. “We had been trained to a high professional standard, and we knew our roles and responsibilities so well that we’d become interchangeable.” 

    Sully credits his crew’s ability to work in concert—safely landing the plane just 3½ minutes after encountering the flock of geese— to the aviation industry’s top-down commitment to safety. “After decades of improving technology, equipment, and training, we began to address the human performance part of safety in the 1980s and 1990s,” he said. “We came to realize that bad outcomes are almost never the result of a single error, but instead a causal chain of events.” 

    Crew Failures

    Postmortems of seminal plane accidents helped the aviation industry see that most failures were crew failures as opposed to individual failures. “In these accidents, someone on the team often had a concern or had knowledge that the decision maker or captain lacked. If that person had shared that knowledge—and had the captain been more approachable—it might have saved the day.” 

    The fatality rate in commercial air travel in the United States was reduced by 83 percent in the 10 years between 1998 and 2008. This dramatic improvement occurred after the federal government and the aviation industry combined forces to dissect accidents and identify and implement high-leverage interventions to prevent future catastrophes. 

    Human Skills 

    Another key change was the adoption of crew resource management (CRM), which is a training program that helps flight crews improve communication, align goals, and create a shared sense of responsibility. 

    “We’ve flattened the hierarchy so the leader is more approachable. We’ve made it psychologically safe to approach a captain about an important safety issue. It’s not about who’s right, but what is right.” says Sullenberger, who helped develop and roll out the CRM curriculum to flight crews.

    Sullenberger objects to the term “soft skills” when discussing CRM. “These are ‘human’ skills as opposed to ‘technical’ or ‘clinical’ skills, and our research is beginning to prove that these human skills have the potential to save more lives than technical skills. By teaching our captains, our team leaders, how to create, build, and maintain a team, we can accomplish things we could never accomplish as a collection of individuals.” 

    The Physician’s Role

    Quoting former U.S. representative James Oberstar, Sullenberger stresses that, “‘Safety begins in the boardroom.’ I think this statement very succinctly gets across that it’s the C-suite leaders who hold the keys,” he says. “They are the ones who have to lead any safety program.” 

    Yet, safety-focused captains are also needed in the trenches. In health care, this role typically falls to physicians. “To create and lead teams, physicians have to have certain attitudes and behaviors that build trust,” says Sullenberger. 

    One protocol that helps in aviation is the short conversation that each crew has before flying together. “After the initial introductions, the captain conversationally aligns goals and sets the proper tone, reassuring the crew that we will all work together to achieve a safe, smooth trip. We then take the time to discuss a few specific safety issues and ask the crew for input.” 

    This conversation essentially creates a pact, says Sullenberger. “The captain confirms that he or she will lead the team and get the crew any needed resources. In return, the crew agrees to be the captain’s eyes and ears. By opening these channels of communication and creating a shared sense of responsibility, we make it psychologically safe for the team members to participate and add to the conversation.” 


    Captain Chesley B. “Sully” Sullenberger III is a retired airline captain, best-selling author, international speaker, CBS News Aviation and Safety Expert, and founder and CEO of Safety Reliability Methods, Inc.