What it takes to be a "Topgun"

Not long ago I gave a presentation to group of Cardiovascular surgeons assembled for their annual conference. The topic was "How to be a Topgun."

The group sponsoring the presentation thought I was qualified to answer that question because of my extensive patient safety work in healthcare and my experience (long ago and in a galaxy far away) as a Topgun instructor pilot for the U.S. Navy. (Yes, the same school for fighter pilots that Paramount Pictures featured in a movie of the same name, starring Tom Cruise.)

After the presentation, I answered questions. One of the last questions was one of the most thoughtful. The surgeon asked, "Steve, you have served in regular Navy squadrons and a Topgun squadron. What's the difference? And my follow up question is this...What is the major difference you see when comparing a Topgun squadron to the average surgical services department of any hospital?"

I paused for a long time before answering. I was worried my response would offend many in the audience. Finally, I confessed my reluctance to answer, offered an apology in advance, and plunged in with the truth.

First, the difference between a regular Navy flying squadron and Topgun is that at Topgun there existed an uncompromising willingness on the part of every Topgun instructor to speak up and demand top performance from his peers. Work-arounds, shoddy effort, selective compliance with standards and protocols, and anything less than your best was just not tolerated. You could bet one of your peers would confront you and demand, in a polite but professional manner, that you clean up your act. Consequently, we operated at a high level and in a way as to not let our colleagues down.

Secondly, (and here was where I was afraid of offending my audience) the difference between Topgun and the average surgical services unit in the average hospital is the rather shocking willingness of administration and peers (of both physicians and staff) to tolerate substandard or disruptive behavior.

Lest you think I am being overly harsh or critical, my comments come from seven years of helping over 75 healthcare institutions implement best practices from aviation. In all that time, I have rarely worked with an organization that didn't raise the issue on their own. "What are we going to do with Dr. Smith? No one in this organization will ever believe we are serious about changing our culture unless we do something about him."

I went on to tell the audience that after years of working in healthcare, I had come to believe a hospital had no chance of creating and sustaining a true "Topgun culture" unless they were first willing to set a standard of behavior and accountability, adhere to that standard, and quickly impose consequences for failing to live up to that standard.

Expecting a sullen silence, I was more than surprised to get the loudest and most spontaneous ovation of the night in response to my answer. Clearly I had illuminated the "elephant in the room" and touched a nerve.

Later that night, as I drifted off to sleep, it dawned on me their response shouldn't have been so surprising. After all, these were surgeons who, despite all of the other options during their annual conference, had elected to spend one of their evenings listening to a presentation on how to be a Topgun. Obviously they had motivation to seek out ways to be the best they could be. In their response to my answer to the questions, they demonstrated they wanted what any high performer wants - to work with and for those who also want the same levels of high performance.

I can't blame them for wanting that. Topgun was in many respects one of the highlights of my professional career. And I have spent my life since then trying to duplicate that same level of uncompromising willingness to hold one another accountable to high standards of performance. It is truly the secret of creating a "Topgun" organization.