Managing Office Staff: What Podiatry Can Learn From The Airline Industry

Lynn Homisak, PRT

Some might argue right out of the gate that running a practice the way the airline industry runs their airlines might be a downright disaster, especially in the area of time management. I might have once agreed as I have had my share of delays. However, when you consider that a major airline like Continental (now United) had as of August logged in 6,000 flights per day and shows an overall 85 percent success rate with departures and an 82 percent success rate with arrivals during the months of May and June 2011, the airline’s reputation is not as bad as you might have believed.1

   Meanwhile, there is a reason why doctor’s appointments got the second highest rating of things people hate waiting for. Just try Googling “waiting in doctor’s offices” and you will see the less than complimentary posts and articles about this topic. Have we not learned after all these years of having such a bad reputation that people do not like waiting?

   I have flown over 1 million miles. When you live in Seattle and visiting medical offices is part of your consulting work, it is what you do. I cannot help but notice that despite their (sometimes unavoidable) delays and luggage complaints, the airline companies are successful at what they do best: flying planes. From a safety standpoint alone, given the ratio of air to ground accidents, their record is pretty impressive. states that the odds of being killed on a single airline flight are 1 in 9.2 million.2

   Short of having a small but vocal disgruntled group of customers who are directly affected by bouts of lateness and luggage misplacement, what exactly can the airline industry teach us about how to run our offices and specifically, how to manage staff? They implement what I like to call the Trilogy of H.R. Success: communication, teamwork and training. When you consider that all of these add up to greater efficiency, it is the ticket to airline success and if we let it, it can be the secret to podiatric success as well.

Pertinent Insights On Improving Communication And Teamwork

On a recent flight, I listened in to the radio frequency that allowed me to hear our pilots converse with not only the air traffic control tower but with pilots of other planes as well regarding the flight path activity. I tuned in just as they were about to land. What was mostly gibberish to me was actually a well communicated language that allowed expertly skilled individuals to guide these enormous “tubes with wings” filled with precious cargo up into traffic filled skies and down safely. Much of it, I will admit, I have taken for granted over the years. However, it wasn’t until I heard firsthand the precision of commands and essential cooperation that I realized how well it really works. It has to work since the consequences are severe.

   Ironically, that same night after I arrived at my destination (on time and with luggage in tow), I received an e-mail from one of my clients explaining a recurring troublesome incident with his staff. Besides the fact that their ongoing conflicts were irritating, the staff severely compromised productivity.

   There is no room for personality clashes in the flight team. There is no lying, “it’s not my job” comments, dysfunctional relationships or emotional breakdowns. They must work together as professionals to do what needs to be done. Given the large numbers of planes in the sky at any given moment, without clear communication, compliance and teamwork, there would be disasters of epic proportions and the flight teams know it. This is no small task and is filled with stress. They understand that a successful outcome occurs through cooperation and there is no room for quarrels, backtalk, disrespect or insubordination. They just do it, not part time and not just when it is convenient.

   Based on my years of experience in healthcare, it is fair to say that communication is the number one issue in the majority of offices. This was evident when I visited a large multi-doctor practice on the East Coast. Part of that consult was to meet with all the staff managers and discuss where they felt efficiency breakdowns occurred. As we worked through issues, one manager asked, “I’m confused. Did our doctors actually fly you across the country to ask us what the problems were so you could tell them what we said? They are here with us every day … Did they consider asking us that question?” If their communication skills were modeled after air traffic control, this practice could have concentrated on improving patient care and efficiency systems, but they could not get past their communication roadblocks.

   Teamwork and communication compliment and feed off each other. Through active listening skills, mutual effort and commitment to a successful outcome, shared responsibilities toward a common purpose/goal, clear accepted procedures, dedication and sacrifice (“taking one for the good of the team”), this combination can increase trust and performance.

Why A Hasty Run-Through Won’t Cut It When Training Staff

Another underutilized tool in the shed of success is proper training. While many jobs at the onset appear daunting, airlines make certain their pilots are fully trained. No shortcuts allowed. The level of training that one receives turns that fear into confidence. It is easy for an employer to criticize an employee for not doing his or her job right, but it is often the result of improper or no training, something employers fail to take responsibility for.

   I had the privilege of sitting in the actual cockpit of a Boeing 737-800 simulator to see and feel firsthand what is involved with flying it. As I took my seat among the hundreds of knobs, handles, dials, buttons and levers in front of, above and below me, I could not help but feel intimidated. I got a quick “run-through” from the pilot, who parked himself in the co-pilot seat and began rattling off what he said I needed to know before takeoff. Pull this, check this, lower that … it seemed his instructions were endless. He basically touched on some key points, like how to start the plane, pull back on the throttle, put it in autopilot and drop the landing gear.

   When he completed his 15-minute tutorial, he asked if I had any questions. Even though I knew I was not prepared, off we went. This was an eye-opening event. Even though I (we) landed the plane (thanks to the co-pilot), we crashed as I taxied to the gate. Had it been a real flight, 162 passengers plus crew would not have made it.

   Needless to say, a hasty “run-through” just did not cut it. Yet this is too often how we train staff in many offices. Circumstances are different but the reasons for failure are the same and while hundreds of lives may not be at stake, reputations are.

   Telling is not teaching. Teaching requires much more effort than that. I did not understand a fraction of the requirements to pilot that aircraft. Even though I received a primer of the “hows” of starting and stopping the plane, I did not know the who, what, when, where and whys, let alone the ifs. The bottom line is I could no more fly that plane with any success than a staff person (experienced or not) could be expected to perform his or her duties in the office without the necessary training.

   My philosophy of working in a podiatry practice is and always has been to teach staff how to do everything, even if they are hired to work in one particular area. This does not mean that all staff must be perfect at all roles but they must be proficient. If needed, they can help with all office duties and support co-workers who are out due to illness or vacation.

   The best training tool is shadowing but that does not mean staff members should just follow another staff person around until they “get it.” It means spending time with each member of the team to see what he or she does, and learning how everyone’s role fits into the team puzzle.

   Shadowing the doctor is the most critical because one learns what questions patients ask and how the doctor responds. They will have a general understanding of podiatric conditions plus basic foot anatomy as they watch the doctor explain X-ray findings and the various types of treatments and surgeries they perform. Finally, they can become more anticipatory and prepare specific instruments, supplies, prescriptions, injections, instructions and durable medical equipment items as needed.

   Like pilots, the staff needs to be trained properly. That means not only showing the staff how to do something but also explaining the reasons why. After a detailed demonstration, allow them to attempt a task themselves under direct guidance. Ask questions to determine their knowledge level. Then when you are confident the staff can do something properly, give them their wings and let them fly solo.

   Yes, it takes time (at least three weeks) but providing proper training upfront will help reduce the amount of mistakes that need subsequent correction (and re-correction). Here are some other keys to emphasize for your staff.

• Job descriptions (to identify their roles and responsibilities)
• Performance evaluations (to let them know how they are doing and where they need to improve)
• Cross-training (to be able to fill in any vacant roles to reduce stress and keep the office flow intact)
• Employee manuals (to keep them in the know with respect to rules, regulations and discipline)
• Regularly scheduled in-services (to allow learning and hands on-training)
• Staff meetings (to create and build a “can do” team)
• Mandatory attendance to at least one annual conference.

In Conclusion

Leaving out any of these success tools is analogous to neglecting a key element in flying. A perfect landing without the wheels down is a crash. It is a combination of good communication, teamwork and proper training that the airline industry counts on to keep them flying high. We could all take a lesson.

   Ms. Homisak, the President of SOS Healthcare Management Solutions, has a Certificate in Human Resource Studies from Cornell University School of Industry and Labor Relations. She is recognized nationwide as a speaker, writer and expert in staff and human resource management.

1. Available at .
2. Available at .


Ms. Homisak has only touched on a small portion of what has come out of aerospace engineering. The Crew Resource Manual (CRM) was used as a resource for the writing of Atul Giwandi's The Checklist Manifesto. Many of us are aware of the use of checklists in the OR prior to beginning a surgical case.

The CRM has also been used in developing heuristics and algorithms for anesthesiologists in dealing with OR crises. Doctor Gaba et. al. at Stanford have developed a simulation program (think flight simulation) for anesthesiology residence programs at Stanford and Mass General for instance.

Another resource developed from CRM, Operations Management and In Extremus Psychology is the text, Crisis Management in the Acute Care Setting. It is quite comprehensive and helpful in improving quality of care and patient safety.

Thank you Ms. Homisak for your interesting article.

Jim DiNoivs

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