Podcast #246 – Steve Montague, a Pilot’s Viewpoints on Lean Healthcare, Checklists & Patient Safety




Episode #246 is my second episode in recognition of Patient Safety Awareness Week.

My guest is Steve Montague, who talked about Lean and Crew Resource Management with me in episode #195 in 2014. He's a retired Navy fighter pilot, a commercial pilot, and a consultant for hospitals and health systems… and a fellow Texan and a near-neighbor of mine. See his full bio here.

Today, we're talking about a number of topics, including patient safety and checklists… what's the difference between good checklist systems and bad (and what are the parallels to Lean done well and Lean done badly). We talk about a number of articles and recent events about how NHS employees are afraid to speak up, an Iowa hospital that had four wrong site surgeries in 40 days, and the recent NEJM brouhaha.

See this recent BBC article that touches on how healthcare can learn from aviation: “Hospitals and airlines – on the same safety journey

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For a link to this episode, refer people to www.leanblog.org/246.

For earlier episodes of my podcast, visit the main Podcast page, which includes information on how to subscribe via RSS, through Android appsor via Apple Podcasts.  You can also subscribe and listen via Stitcher.

Thanks for listening!

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Excellent Podcast on the effectiveness of checklists on patient safety.
    I worked for a large oilfield service company back in the 80’s and 90’s and checklists were used anytime we were about to embark on pre-determined high risk operations, notably well treatments and truck convoys to and from well sites. Some suggestions about “surgical timeouts:”
    1. This may sound somewhat irrational but I would change the name of this event as the connotation is childish and you are about to start a high risk operation. In oilfield we called them Operational Safety meetings.
    2. Our meetings were conducted by the highest ranking person.
    3. It was mandatory everyone on the well site attended, not only the employees from our company.
    4. Most job positions had checks they had to make before the meeting and reviewing the outcomes were part of the main checklist.
    5. All key measures were discussed as to the intended levels we would see during the operation.
    6. “What ifs,” were discussed, as to if something went wrong what were the countermeasures.
    7. Each person’s name was read out loud and their role in executing the operation.

  2. Good morning from sunny Santiago, Chile, Robert.

    I think the ship has sailed on the name (timeout) although some organizations have opted for “surgical pause”. As to the rest of your comments, they’re exactly what we recommend to our Partner hospitals when it comes to this event. Specifically:

    Everyone who will be a part of the surgery is present and attentive
    It’s interactive, with everyone commenting on their readiness (safety checks complete)
    Milestones and outcome expectations
    Most likely contingencies
    Introductions of everyone on the team.

    There are a few more elements that we often see, such as a comment on fire risk, anticipated blood loss and availability, and a request that all team members speak up with concerns at any time. Some of our suggestions made it into the final cut of the WHO Surgical Safety Checklist… others didn’t :-(

    Thanks for your kind comments, and for your dedication to helping healthcare get better.

    Have a good weekend.


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