by adgrooms on June 19, 2019

On March 27, 1977, two Boeing 747s collided killing 583 on a runway in Tenerife, in the Canary Islands, off the coast of Morocco. This accident led to a new era of standardization and safety in aviation. Aviation studied its vulnerabilities and innovated to be a much safer form of transportation with .07 deaths per billion passenger miles, reducing the number of commercial fatalities from the thousands at the time of the Tenerife accident to a few hundred in recent years.

Medical errors and injuries are an ongoing problem for healthcare. Are there systemic gains that aviation has accomplished that healthcare can use to improve outcomes?

In comparison, both professions require years of rigorous training. One difference is that aviation includes extensive leadership, decision making, teamwork, and other non-technical skills where physicians receive little, if any, of this line of training. Physicians are required to interact with patients and staff as a leader while making numerous difficult decisions. Why wouldn't this type of training and support be provided in healthcare?

The safety initiative in aviation discovered that lack of communication was the root cause of many accidents. One response was a move to flatten hierarchies. The captain is in charge and has the last say in decision making, but if a co-pilot sees a problem, they are encouraged to speak up, not shut up. Collaborative approaches like team-based care have a positive impact in the clinical setting, but it only works if every team member feels valued and each voice is welcome. A culture of mutual respect for every role is needed for a cohesive, well-functioning medical environment.

The healthcare industry needs to provide an avenue for physicians to report a mistake without fear of repercussion. Aviation has cultivated a culture of reporting mistakes through the Aviation Safety Reporting System run by NASA. It is a place where pilots, air traffic controllers, flight crew, and maintenance can report errors voluntarily. The reporting is then used to improve whole systems, not to punish individuals. This allows for constant improvement in safety processes that benefit the whole industry. Healthcare already suffers from too much bureaucracy but a similar, industry-wide reporting system could simplify and standardize reporting while creating a culture of safety and a shared resource for improvement.

Aircraft have systems that collect a massive amount of information. This information is used to refine workflows. Much of the process has been automated such as controlling the plane in level flight. Healthcare has gone in the opposite direction with the implementation of EHRs. Doctors are burdened by required manual input in clunky interfaces. Modern aircraft interfaces offer inspiration to the development of more robust clinical software.

Airlines invest heavily in the wellbeing of their staff. There are strict guidelines on how much pilots can work, and psychological staff are readily available for support. This is not necessarily the case for physicians. With ongoing shortages, physicians are working longer hours, and burnout has become a heavily discussed problem. The safety improvements of the airline industry provide good justification to healthcare for making similar investments in the wellbeing of their team.

There is an effort in health care to learn from aviation. Captain Chelsea "Sully" Sullenberger, famous for the miracle on the Hudson emergency landing, speaks to doctors on improving systematic processes in the pursuit of patient safety. Although there are differences between the two disciplines, safety and the outcomes of patients/passengers are a shared objective.