By now, many of you have started to read Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care by John Nance. If not, you are in for an engaging read that starts by sharing the unfortunate story of the worst accident in commercial aviation which occurred at the Tenerife airport in 1977, killing 583 passengers aboard two different 747s and influencing cultural changes to aviation and other high reliability organizations around the world.

The author’s assessment of this event told through his character Dr. Jack Silverman, highlights the communication and cultural missteps that contributed to the unfortunate outcome–one of which being The Halo Effect. The Halo Effect, defined by psychologist Edward Thorndike’s empirical research, is the cognitive bias where people seen as knowledgeable or highly respected in a given area are given deference across the board. In the Tenerife example, neither the co-pilot nor the engineer challenged the highly decorated pilot, because he was “who he was” even though it is thought they had information that could have changed the outcome.

While aviation has changed dramatically over the past 30+ years, evolving into an exemplary model of what a high reliability organization looks like, health care still has a long way to go. The Halo Effect is just one aspect of the predominant healthcare culture which remains hierarchical in nature, and often devalues the contribution of those less experienced or lettered even though all involved in a patient encounter–patient, family, nurse, allied health professional, pharmacist, student and physician–have something of great value to offer.

Can you share an example of a time you had something to offer to a patient encounter, but held back because you thought an attending or senior physician would not welcome your comments? Or because you thought they must know better? Was there a time you pressed on in light of the perceived consequences? How did your choice impact the patient’s experience?