Southwest Airlines Flies One Plane. Your Practice Should Too.

Southwest Airlines has built its business around one aircraft type. At the end of 2024 it operated 803 aircraft, every one of them a Boeing 737, and its annual report is direct about why: "Southwest's use of a single aircraft type has historically allowed for simplified scheduling, maintenance, flight operations, safety management, and training activities."

The same filing lists the reverse as a business risk. A shift away from a single fleet type, it says, "could also add complexity to the Company's operations, present operational and compliance risks, and materially increase the Company's costs."

A multi-location medical practice isn't an airline. But it faces a version of the same choice, usually without realizing it's making one.

What "one plane" actually buys

The benefit of a single fleet isn't that the 737 is the best aircraft for every route. It isn't. The benefit is that everything around the aircraft becomes interchangeable:

• Any pilot qualified on the type can fly any plane in the fleet.
• Mechanics work from one body of knowledge and one parts inventory.
• There's one set of procedures, one training program, and one manual.
• When a plane is out of service, another can take its place without retraining a crew.

Standardization turns a collection of assets into a system. The gains show up in scheduling flexibility and in how quickly the operation recovers when something goes wrong.

Your practice's mixed fleet

Now look at a typical multi-location practice. Location one books through the EHR's built-in scheduler. Location two, acquired later, kept its own scheduling tool. Location three uses a different texting service for reminders because its manager signed up before anyone compared notes. Intake is a PDF at one site and a web form at another. Each location keeps its own spreadsheet for follow-ups.

Every one of those differences is a different plane type, and each carries the costs Southwest's filing describes.

Training. A new front-desk hire learns the tools at their location, not the practice's. In a May 2025 MGMA Stat poll, practice leaders named front-office staff and medical assistants as the most frequent turnover hotspots. Those are the roles that touch the most systems, and they're the roles you train most often.

Coverage. When someone calls out at location two, can a staff member from location one cover the desk? If the tools and workflows differ, the honest answer is "partly," and patients notice.

Switching. Every extra system is another context switch. A study published in Harvard Business Review found that workers toggled between applications nearly 1,200 times a day and lost just under four hours a week reorienting themselves.

Oversight. When each location runs differently, comparing them is hard. Reporting becomes an export-and-reconcile exercise instead of a report, and problems at one site stay hidden longer.

What a mixed fleet costs, in round numbers

The costs are easy to underestimate because none of them arrives as an invoice. A rough estimate helps.

Consider a hypothetical four-location practice that hires eight front-desk and medical assistant staff a year. If each new hire spends an extra 12 hours learning location-specific tools and workarounds that a standardized setup wouldn't require, that's close to 100 hours of paid time a year, before counting the colleague who trains them. Add the cover shifts that can't be filled across locations, the manager hours spent reconciling reports, and the errors that come from people working in unfamiliar systems, and the total climbs quickly.

The exact numbers will differ for every practice. The pattern doesn't: each extra plane type adds a small, recurring cost to every hire, every absence, and every report.

Where the analogy stops

It's worth being honest about the limits.

Southwest's "one plane" is really several variants of the 737: the -700, the -800, and the MAX 8. Standardization tolerated variation where it didn't break interchangeability. A practice can do the same, allowing differences that don't change how staff work.

A practice also has clinical needs an airline doesn't. A location that offers surgical procedures and one that doesn't may need different clinical tools, and forcing them into an identical setup can do more harm than good.

And a single platform concentrates risk. Southwest's filing says plainly that the company "is currently dependent on Boeing as the sole manufacturer of the Company's aircraft," and it cites the FAA's March 2019 grounding of all Boeing 737 MAX aircraft as an example of how regulators can take planes out of service with little notice. A practice that consolidates onto one system takes on a smaller version of the same exposure. It should have a written plan for running scheduling, check-in, and payments when that system is down, and a clear right to export its data.

The lesson isn't "one vendor for everything." It's one way of working, supported by as few systems as the work requires.

Standardize the process, then the platform

The order matters. Software can't unify locations that work differently; it just records the differences more neatly.

1. Write down the core workflows once. New-patient booking, intake, check-in, checkout, rescheduling, and follow-up on unpaid balances. One version, agreed by every location manager.
2. Name the places locations genuinely need to differ. Specialty clinical work, state rules, different service lines. Keep those differences deliberate and documented.
3. Choose the systems that support the standard. For the shared operational work of scheduling, intake, communications, staff, and reporting, aim for one system across all locations.
4. Make new locations adopt the standard on day one. Every acquisition or new opening is a chance to add another plane type. Decide in advance that you won't.

The operational layer is usually where standardizing pays back fastest, because it's where locations drift apart the most. Localhost Labs builds that layer as one system for multi-location medical practices, on a month-to-month subscription, but the steps above are worth taking whatever software you end up using.

What to do this week

Make a simple grid. Put your locations across the top and your daily tasks down the side: booking, intake, reminders, check-in, payments, follow-up, reporting. In each cell, write the tool and the process that location uses. Every row with more than one answer in it is a place your fleet is mixed.

Then circle the rows where the difference genuinely serves patients or a clinical need. Those can stay. The rest are candidates for standardization, and the list is usually longer than expected. Start with the row that affects the most staff every day, which is often booking or intake, because that's where one standard pays back soonest.

Bring the grid to your next partners' or managers' meeting. It usually makes the case more clearly than any cost estimate. For the cost side, the 30-minute software audit and the $47,000 spreadsheet cover where the money and the risk tend to hide. If you'd like to talk through your own grid, you can book a call.

If you're weighing what a fix would cost, our guide to how much custom software costs breaks down build, maintenance and three-year totals, and the software stack cost calculator adds up what your current tools cost today.