How to modernize healthcare? Take cues from the airline industry

October 27, 2016 Bruce Knepper

The airlines fly full. They fly 24-7. They fly the right size planes. They fly safely.


Debuting in 1959, Douglas’s first jet engine-powered transport aircraft, the DC-8, was a mainstay of the airlines in the sixties and seventies. But today, these iconic workhorses are gone from commercial traffic. Why did those planes disappear? They got old and tired. They were noisy. They guzzled fuel. They had limited seating capacity.

Yet, despite the amazing advances in medicine over the last past century, the 1950s hospital is still here. And there are thousands of them.  

I must be out of my mind to think that the healthcare industry could take a lesson from the airline industry, but having given it some thought, I think there’s something there.



Over the last decade or so we have seen the airline industry transform itself. The air travel business was near collapse in 2005, but today it is robust and prospering. The big four domestic carriers earned profits of $22 billion in 2015. Why didn’t I buy stock in one of the airlines? Airlines have benefited from consolidation and low fuel prices, but market demands have also pushed modernization and efficiencies.

Hospitals, on the other hand, have seen some modest transformation over the past decade but not nearly enough. With a booming aging population that needs healthcare, there is much to do and little time to do it.

Yes, the 1950s Hill-Burton Hospital remains with us. It is old and tired. It is slow and energy inefficient. These aging healthcare facilities can’t handle today’s patients and mode of treatment.

Change is hard, but change we must.

An obsolete model
The hospitals of the fifties and sixties were designed around the prevalent model of the era, inpatient care. The medical center of tomorrow (and today) must be focused on treating the patient regardless of “in” or “out” status. Today, outpatient care is the mode of choice for providers and we will only see it expand in the future. Why then are we still providing medical care in a DC-8? The industry’s focus on the cost to build might have precluded it from undertaking new facility designs that could help control the cost to operate.


Always open, always earning
Hospitals are one of the most expensive building types to build and operate. Typically, hospitals are quite busy Monday thru Thursday with many services and floors closing on Friday, Saturday, and Sunday.

The airlines run 24-7-365. When the planes are not flying the airlines are not making money. Planes are expensive. Hospitals are expensive. Operating rooms cost upwards of $4 million each to build, so why are they not in use routinely after 3pm? Why are they dark on the weekends?

The healthcare industry talks about patient satisfaction so why not take another lesson here and expand those hours to be more convenient to the patients? Schedule surgery on Saturday, recover on Sunday and have the patient back to work on Monday so they won’t lose time at work. MRI and CT scanners, once again multi-million dollar machines, should run seven days a week. Why not get your MRI on Saturday afternoon?

Right sized 
The hub and spoke model is a hospital and airline planning staple. As a frequent flyer, I often prefer a direct route, but I understand that a half-empty plane doesn’t pay for itself, neither does a half-full hospital. The airlines have embraced the regional jet, a vehicle that is the right size for the job. This is where the healthcare industry can learn another lesson. Those big old hospitals need to become the regional jet or the Airbus A380 as needed in their market.

The airlines fly about 1.7 million passengers every day in the United States. U.S. hospitals treat millions of patients every year. But it’s air travel that has the enviable safety record.

Hospital errors, research estimates, lead to 440,000 preventable deaths a year in the U.S. In contrast, a total of 641 people died around the world in commercial aviation last year. The rate of serious jet accidents hit a historic low in 2015 according to the International Air Transport Association.

So let’s put aside that memory of your last in-flight meal for a moment. We can acknowledge that airlines vary in their ability to make comfort and convenience a part of this efficient and safe experience. That’s no reason not to take a look at the more nimble airline industry and see where we can draw some important lessons for healthcare delivery.

The airlines fly full. They fly 24-7. They fly the right size planes. They fly safely.

Now, let’s talk about those airplane bathrooms… they could use a little attention.

About the Author

Bruce Knepper

With over 40 years of project experience, Bruce—a specialist in healthcare design—is responsible for our US East Healthcare sector. A founding member of the American College of Healthcare Architects, he’s designed and been responsible for all aspects of healthcare facilities.

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