Hey Reader,

📊 Historical Context and Safety Record

It hasn't been since 9/11 that the FAA has been in the spotlight like it is right now. The reason it has not been in the spotlight until now is because everything has been working as it should. It wouldn't be in the spotlight now if it wasn't for politics and the most recent incident. We should be celebrating the safety record the FAA has achieved instead of looking for blame. The numbers back this up. In 1990, the accidents per million departures was 4.33. In 2023, it was 1.3, even though the number of departures increased by 20,000 per day in that same period. The last fatal commercial airline incident was in 2009. The task has grown more difficult while the rate of success is growing even faster.

🏆 FAA's Defining Moment: 9/11 Response

On 9/11/2001, the FAA grounded all aircraft in the entire national airspace. This was recognized as a heroic action because of the immense complexity of the maneuver. It was the professionalism and talent of the entire organization on full display that day. Everyone on the inside sees this every day. The FAA has a safety culture where blame is removed from the process of improvement and replaced by learning. This is a culture that is being modeled in healthcare as well. There has been no determination as to the FAA's part in the most recent incident, but no doubt there will be changes as a result of what is learned in the investigation.

👨‍✈️ My Personal Experience in Aviation

I was in aviation and the FAA for 10 years of my career. I started as a radar engineer when the Capital Investment Plan (CIP) modernization project was ramping up in the early 1990s. During my time there, I worked on many systems and in many roles. I saw the dedication and talent that was all around me. I was there for some of its biggest changes and challenges. In my career, I have worked in the military, federal service, the private sector, all the way to building my own startup. If anyone thinks that quality and safety are done better in the private sector, they are wrong. Of all the places I have worked, I have never seen it done better than the FAA.

🔄 Culture of Continuous Improvement

The continued successful record of the FAA is largely because of its culture of continuous improvement. Continuous improvement requires feedback to correct errors and defects. The FAA's improvement culture is enabled by its safety culture that encourages open and constructive feedback. In contrast, the blame culture constrains feedback, and as a result, improvement eventually stops. The FAA's safety culture creates a safe environment for self-reporting of incidents, errors, and defects which allows improvement data to flow. Leadership is evaluated on how they support this culture.

💻 Technology's Role in Safety

Another big part of the improvement feedback is technology. Systems are in place to record the entire event stream, and incidents can be reconstructed, played back, and analyzed. Even though self-reporting opens up the feedback loop, it is still based on human recollection and human emotion, so it can be flawed. In the FAA surveillance is not a dirty word, and it is what enables the safety systems. Technology relieves humans from the burden of having to make complex decisions about what and how to report. Sometimes humans report based on incomplete information, so technology is also there to help fill in the gaps.

🏥 Lessons for Healthcare

Healthcare workers often look at technology as something that removes their autonomy instead of a tool for continuous improvement. This may be more of a symptom of a bigger problem, which is the lack of a strong safety culture. Technologies that track and observe can be viewed as "big brother" instead of part of a culture, free of blame, that uses improvement tools supercharged by digital feedback. Those who cite the litigious environment of healthcare should be reminded that aviation is also in a litigious environment. Healthcare should learn from aviation and embrace technology as a tool that can support improvement. But that technology should not exist without a strong safety culture that emphasizes its use for improvement instead of evidence.

🤝 Cross-Industry Learning

Aviation and Air Traffic Control have used learnings and best practices from other industries like space, utilities, manufacturing, and even the military. The open exchange of ideas is part of the drive toward quality, and Care Traffic Control is a reflection of quality best practices from many industries. Healthcare is becoming more open to change and the open exchange of ideas. Translating ideas into culture is a more difficult task. Transformation is something you hear a lot in healthcare, and the word has connotations of dramatic and rapid change. The desire for transformation is noble, but the strategy to do so is where the work begins. As always, here is my calendar if you want to learn more.

Until next week,

Paul E Zieske ​Location Based Services Consulting ​​​