Why Captain Chesley “Sully” Sullenberger Would Have Been a Great TPMG doctor

One of my roles as an Elected Representative for the Roseville Medical Center was to write monthly newsletters to inform and update colleagues about changes both internal and external to Kaiser Permanente. I’d also pen original pieces which highlighted themes I felt were critical for our organizational success in becoming the model for health care in the nation. This one is from the August 2010 Elected Rep Newsletter. It is still one of my favorites.

I recently read Highest Duty: My Search for What Really Matters by Captain Chesley “Sully” Sullenberger, the pilot of US Airways Flight 1549, forever known as the Miracle on the Hudson, to learn more about aviation safety and see if there were parallels to patient safety. What I learned was far greater. Doctors and the healthcare industry have opportunities to do much better beyond just patient safety. The reason he and his flight crew were able to land a fully disabled plane in under four minutes can be attributed to the following qualities: his mindset, his professionalism, meticulous attention to detail, a willingness to learn from others and his intrinsic desire to be even better, his humility, integrity, and his thoughtfulness.

A Pilot’s Pilot

As his wife describes him, he is a pilot’s pilot. By five he knew he would spend his career flying, and by age sixteen he was flying solo. At twenty-four as an Air Force fighter pilot, he understood that he needed to be attentive to detail and pay the “closest attention to everything, because life and death could be separated by seconds and by feet.” He flew extensively and often at the Air Force Academy. In 1973, he graduated and was named “Outstanding Cadet in Airmanship”. His passion for flying, his enthusiasm to get even better and his commitment to challenge himself continued at US Airways. One night landing in San Francisco when there was little traffic and air traffic control provided pilots latitude on a clear night with smooth air, Sullenberger could see SFO sixty miles out. He realized that if he descended at the right spot that he could throttle the engines on near idle all the way in. He could avoid using the speed brakes, which rumbles the cabin, and manage perfectly the energy of the jet.

• “It was a smooth, continuous descent,” he told his wife, “one gentle slowly curving arc, with a gradual deceleration of the airplane. The wheels touched the runway softly enough that the spoilers didn’t deploy immediately because they didn’t recognize that the wheels were on the ground…I’m guessing no one on the plane even noticed. Maybe some people sensed it was a smooth ride, but I’m sure they didn’t think much about it… I was doing it for myself.”.”

His wife Lorrie notes that he loves “the art of the plane”.

Willingness to Learn

Yet as technically capable as he was, he also actively involved himself in accident analysis. He realized the importance of understanding how flight crews reacted in emergency situations to train them even better to increase the odds of success. Although arguably he was already an accomplished pilot, his willingness to learn from others meant he became even better. Being the best also relies on teamwork. The standard at US Airways is for a crew to meet together before the trip, typically before passengers board. It’s not unusual to fly with an unfamiliar flight attendant or first officer as US Airways. Despite workforce reductions, there are still 5,000 pilots and 6,600 flight attendants (TPMG has 7000 doctors and 24,000 support staff).

• “It’s vital to make individuals feel like a team quickly so that they can work almost as well together on the first flight as they naturally would after having flown several flights together.”

With the new crew at the beginning of the fateful week, Sullenberger as the captain knows it’s his role to set the tone and to be approachable. He told them that he was looking out for them, wanted to know what they needed to do their jobs and would try to help.

Feeling Privileged and Making the System Better

Despite the reductions in pay, benefits, and the loss of prestige in flying, Captain Sullenberger still feels very privileged to be a pilot and fly. His professionalism extends beyond the flight. When he was 13 years old in 1964, he was stunned to hear the story about thirty-eight New Yorkers who ignored the screams from twenty-eight year old Kitty Genovese, who was sexually assaulted and stabbed to death by a stranger. Dubbed “the bystander effect” by sociologists later, at that young age Sullenberger vowed to always help someone in need – “not on my watch.” Only one of many examples included arriving in Hartford at 10:30 pm after a long day. He helped a young couple with their toddler locate their stroller. After he walked down the stairs to the tarmac and spoke to the baggage handlers did he discover that the stroller never made it from Philadelphia. As the airport closed down, he escorted the family to baggage claim and showed them where to file a claim. A flight attendant noted that not every pilot or flight attendant would have bothered to help.

• “A lot of people in the airline industry… feel beaten down by circumstance…We’ve been through pay cuts, givebacks, downsizing, layoffs. We’re the working wounded…People get tired of constantly fighting the same battles over and over again every day. The gate agent hasn’t pulled the jetway up to the plane in time. The skycap is supposed to bring the wheelchair and hasn’t…At the end of a long day, you and your crew will get off the plane and make your way out of the terminal, but the hotel van isn’t there where it’s supposed to be… At all airlines, there are many employees, including in management, who care deeply and try to make things better. But at some point, it can feel like a fine line between letting passengers fend for themselves and enabling the airline’s inadequacies. And so it becomes a decision whether to do the simple, easy act of walking a young couple and their toddler to baggage claim.” “My way of handling these issues is to fight to improve the system but still help those I can.”

The Meaning of Integrity

Years earlier, he was asked by his nine year old daughter about the meaning of integrity. “Integrity means doing the right thing even when it’s not convenient.” He continues, “integrity is the core of my profession. An airline pilot has to do the right thing every time, even if that means delaying or canceling a flight to address a maintenance or other issue, even if it means inconveniencing 183 people who want to get home, including the pilot. By delaying a flight, I am ensuring that they will get home. … I am trained to be intolerant of anything less than the highest standards of my profession. I believe air travel is as safe as it is because tens of thousands of my fellow airline and aviation workers feel a shared sense of duty to make safety a reality every day. I call it a daily devotion to duty. It’s serving a cause greater than ourselves…”

January 2009

So on that fateful winter day in January 2009, Captain Sullenberger and his crew on a routine flight soon encountered the unthinkable – a double bird strike on takeoff shutting down both engines. Critical communications and decisions occurred between captain, co-pilot, and air traffic control in flying the disabled plane, assessing his options return to LaGuardia, trying to make it to Teotoboro, New Jersey, or to ditch in the Hudson River. It also required his lifetime of deliberately acquired experiences and knowledge to avert what everyone, except Captain Sullenberger, expected to be a tragedy. Though he and his co-pilot did not know until their debrief a few days later, the entire sequence from bird strike to landing in the Hudson lasted exactly three minutes 28 seconds.

With the national psyche bruised after a contentious presidential election, unsure of itself battling two wars, burned by greed and selfishness on Wall Street, and beaten down in the midst of the worst financial crisis in US history, the unlikely safe landing of US Airways Flight 1549 against impossible odds restored Americans faith, even for a brief moment, that hard-work, integrity, humility, and professionalism mattered.

Learnings for TPMG Doctors with Health Care Reform

As TPMG doctors, we can learn a lot from his story. With healthcare reform, the public is understandably worried what the future holds. As doctors, naturally, we are equally concerned as well.

Yet, no one is better to lead than our medical group.

No one is better to lead than you.

• Do you aspire to be a doctor’s doctor?
• Do you work deliberately to improve your surgical skills, physical examination, diagnostic acumen, communications with patients and colleagues, and even more precise use of imaging and lab testing if simply for the intellectual challenge?
• Will you be humble and thoughtful enough to learn from the experiences and mistakes of others to protect patients from avoidable medical errors and preventable complications?
• Are you willing to look out for others and help out, not only in your department, but other medical specialties both locally and regionally?
• Will you be willing to fight tradition and the status quo to find newer better ways to provide care to members that is incredibly simple and convenient?
• Do you set the tone everyday with your support staff on what you expect and how your team functions whether in the office, hospital, or operating room?
• Can you continue to have a mindset of professionalism that is reflected in your dress, appearance, manner, and behaviors? Despite all of the challenges, turmoil, and uncertainty of healthcare reform and the operational changes that we do, can you still remind yourself of the privilege to help others?
• Can you recall why you became a doctor in the first place?

It’s these little things that matter. When each of us do our jobs extraordinarily well, whether it is specialists reminding members to get their blood pressure checked or getting mammograms to screen for breast cancer, telling our staff not to turn late patients away or to ask them to force book a patient on our already busy schedule, improve processes to do today’s work today whether in primary care, specialty care, hospital, pathology, and radiology, adhere to procedures and checklists to prevent injuries and medical errors, members won’t know all of the hard work we have done.

We won’t get any immediate praise, awards, or recognition.

Nor should we.

We are professionals.

This is what we do.

This is who we are.

We are doctors.

Even better, we are TPMG physicians.

And most importantly, these are the right things to do.

Highest Sense of Duty

Captain Sullenberger concludes his story this way: “I’m sure there will be passengers of future US Airways flights who will look toward the closed cockpit doors and wonder: Who is flying this plane today? Most likely, the captain will be one of my colleagues, an aviator who is well disciplined and well trained, with the highest sense of duty and a great love of flight…. Then again, the guy behind that door may be me. Once we’re in the air, I’ll say a few words about the cruising altitude, the flying time, and the weather. I’ll remind passengers to keep their seat belts fastened, because turbulence often comes unexpectedly. And then I’ll switch off the public address system, and I’ll do my job.

Captain Sullenberger would have made an amazing TPMG physician.

Update from July 1st, 2016

The new film Sully starting Tom Hanks and directed by Clint Eastwood will be out in September. I can’t wait. Looks amazing already.

Highlights from the trailer:

No one warned us. No one said that you were going to lose both engines at a lower altitude than any jet in history. This was dual engine loss at 2800 feet followed by an immediate water landing with 155 souls on board. No one has ever trained for an incident like that….

[Investigator] – Simulation showed that you could make it back to the airport.

[Sully – Hanks] – Not possible. I felt it go.

…What if I did this wrong? What if I did endanger the lives of all those passengers?

…With over 40 years in the air, but in the end I will be judged on 208 seconds…

…I need a count, passengers and crew. Is anyone still here?

Already you see so many qualities that each of us can learn from – deep expertise and learning that only come from curiosity and experience which simulators can’t at this time outdo a expert; self-critical introspection, which often trait for those trying to better; honor and duty, which comes from within but no doubt was reinforced with this Air Force training.