Book Report – The Southwest Airlines Way: Using the Power of Relationships to Achieve High Performance 

Author: Comptom Broders, MD, FACEP, FACP (Professor, UT Southwestern) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)

The Southwest Airlines Way: Using the Power of Relationships to Achieve High Performance by Jody Hoffer Gittell published in 2003


This report was originally done about 2004 for the THR Physician Connection.  I was PLC chair at the time.  It is recreated today from old notes.

Having lived most of my adult life in Dallas, I have observed Southwest Airlines over the 3 decades of their existence.  I have often wondered if their experience could have relevance to healthcare.  This book in my opinion gives a resounding yes to that query.

Southwest has been profitable every year except its first.  It is arguably the most profitable airline in the business.  And yet the morale and sense of fun at Southwest consistently remains high, and they consistently win awards for satisfaction, on time arrival, and baggage handling.

How do they do this?   The book gives insights into this success.  In a nutshell the main reason is an intense focus on RELATIONAL COORDINATION.

The employees are nice, like people, know what they are doing, work well as a team, and work in a highly coordinated fashion.  In other words, Southwest Airlines is in the relationship business, and this is hard wired by 10 organizational practices.

The 10 practices are:

  1. Lead with credibility and caring
  2. Invest in frontline leadership
  3. Hire and train for relational competence
  4. Use conflicts to build relationships
  5. Bridge with work-family divide
  6. Create boundary spanners
  7. Manage performance broadly
  8. Keep jobs flexible at the boundaries
  9. Make unions your partners
  10. Build relationships with suppliers

To flesh out the second tenet—investing in frontline leadership, Southwest has supervisors for every 10 to 12 people. They are seen as player coaches to help the line work when needed and to interface with other frontline employees as needed to accomplish the Southwest goal of keeping the planes flying and safely. “Southwest has more supervisors per frontline employee than any other airline in the industry”.

Another practice that stands out at Southwest is “they create boundary spanners”.  A critical operation for an airline is the departure.  At Southwest each departure is coordinated by one “operations” agent. Other airlines have 3 to 15 departures per agent.  By actively interfacing with the many components of the departure process and by creating personal relationships with these components—bag handlers, gate agents, fueling, mechanics, pilots, etc., the departure process for Southwest is the best in the business.

All of these 10 processes interact with each other to create a highly reliable, safe, and frequently fun flying experience.

What are the potential lessons for healthcare?  Jody Gittell says that relational coordination is most valuable for performance in settings with 3 characteristics:

  1. Task interdependence
  2. Uncertainty
  3. Time constraints

Does this sound like healthcare?  It does to me.

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