For the first time in a while I spent fully half the weekend NOT working at anything but my embarrassing golf game and some online sleuthing into what I am convinced is a foolish "can't lose" medical device investment that a friend is trying to get me to participate in (before the greedy people grab the opportunity). So when I finally picked up Friday's (August 14) Wall Street Journal print edition on Saturday night and was immediately drawn to the front page feature: Flying Low Is Flying High As Demand for Crop-Dusters Soars, I wasn't sure what instinct was drawing me to relate it to the experience of health care leaders. Well the 24 online comments as of this writing, all by and about the "ag pilots" celebrated in this article, revealed no health care gadflies leaping to make the connection. So here goes...
Who Would Pull a Stunt Like This?
This piece is about the resurgence of interest in crop dusting as a professional niche among pilots - now that the major airline industry is teetering and the commuter lines offer sub sub entry level pay as reward for trying to consistently fly people safely while being neither well fed or well rested. Apparently crop dusting pays better and offers pilots the opportunity to "really fly" and be "at one" with an aircraft:
"Pilots are drawn to crop-dusting not only for the money, but also for the chance to be their own bosses and to do the kind of low-altitude flying and stuntlike maneuvers one wouldn't dream of performing in a big jet."
Wasn't this part of the reason many people went into medicine, nursing, and health care entrepreneurship years ago? To be close to the action, to have a role in wiping out disease and misery, to make way for the healthy growth, and to determine one's own destiny just a bit? (I'm convinced that Jonathan Welsh, the author and a staff writer for the automotive section of the WSJ, must have been subliminally thinking about health care when he wrote this piece. After all, he married a pediatrician and is the son of a dental office manager. He must get it.)
Raising a Health Care Crop Duster
Does Welsh's article suggest that there's still a way to get back to basics and to break out after years of being constrained by the ever tightening world of health care regulation, diminishing reimbursement, increasing litigiousness, and widespread cynicism about the commitment of health care leaders to health care? If there is such a path, does it involve coming down from the stratosphere of the executive management level reports and reacquainting health care leaders with what is happening on the ground?
"...[One crop duster trainee] considers himself a good pilot but is quick to admit that he lacked a feel for what the plane is doing because so much of his flight training had focused on instrumentation....To be a good crop-duster, he says, a pilot has to be intimate enough with the airplane that flying it becomes second nature. Knowing which controls to move and how to coordinate them precisely helps him feel at home in almost any type of plane. But flight schools no longer teach those basic "stick and rudder" skills, he says."
Is health care improvement, at least in part, about mentoring emerging leaders closer to the ground? Do we rely too heavily on high tech instruments and not enough on the "visual flight rules" that govern low altitude piloting? That's not to say that we'd want to be in a full size jet (complex health center or health related company) without them. But what got USAir Flight 1549 safely to the ground (well, to the water anyway) earlier this year was the fact that the pilot, "Sully" Sullenberger, regularly flew gliders and other small aircraft and had some instincts about how an airplane behaves. Even without much of that other stuff.
Learning by Doing
Our instruments are, of course, different from those in the cockpit. As clinicians they are lab tests, xrays, electronic monitors, the EHR, clinical simulations, etc. As health care executives they are dashboards, quarterly financials, consumer satisfaction surveys, and dynamic models. And we are increasingly comfortable using them as proxies for teaching about how to handle what happens on the ground or at the bedside.
Is this enough? Is it how we should train and mentor our emerging health care leaders? I'm not just talking about having general intelligence about operations, or managing by walking around (MBWA), but about having the instinct, skill, and experience to know exactly what it takes to solve complex health care problems in the trenches, occasionally even solving them, and enjoying the process:
The problem with most pilots, [the instructor] believes, is that they work to reach a certain skill level, become content and stop seeking improvement. He worries that [trainee] enthusiasm will eventually wane. "In the end he'll have to decide whether to settle for being a hack airplane driver or become a real pilot who never stops learning."
You never know when that might come in handy.
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