The Airlines and Avoidable Error

By Andy Smith, Publisher of HealthcareTrainingandEducation.com and Medical Training Magazine

The Times of London printed an editorial early this year by Professor, The Lord Darzi, on ‘Never Events’ – those catastrophic healthcare errors that are deemed should ‘Never’ occur but of course still do and with an annoying persistence.

As with all features in digital format, the ‘Comments’ came thick and fast and were mostly of excellent quality, both well informed and thoughtful, quite a novelty in today’s shoot from the hip ‘all opinions count’ universe. A mention was even made of the safety record of the airlines!

The one that bucked the otherwise positive trend was, given the content, almost certainly written by a surgeon and effectively amounted to a ‘this is irrelevant, we are wasting time, I have more important things to do, and nothing can be done’ tirade against change, i.e. improvement. The title of this piece is taken from that comment.

So let’s talk about the airlines.

Quite simply, we should be looking at what the airlines have done to achieve their outstanding levels of safety because the comparative global healthcare safety record is appalling. Moreover, we should be looking for support from any ‘industry’ that does difficult and dangerous things well because healthcare does not match up against them.

If you wish to question that comment, then consider the 251,000 deaths through medical error on average in the US healthcare system (probably more) annually against 0 deaths through error in the US airline sector in 2014.

Pilots, cabin crew, maintainers, traffic controllers, i.e. the airline team, are attempting to do the same as the healthcare team; deliver a 'client' safely through their system and out the other side. Of course the healthcare team is dealing with sick patients some of whom, however good the care, will not survive. What Professor Darzi was talking about, and is the subject of this piece, was avoidable error and quite simply the airlines handle their safety process far better than healthcare does.

The airlines designed a culture change 40 years ago to create their current safety based business. Healthcare needs to do the same and it is time for the leaders of the healthcare team to stop trying to halt the process and lead it to ensure it is done most efficiently. The alternative is to wait until someone imposes change upon them.

Realistically we may have to wait for generational change. It is hard for those who consider themselves at the top of their profession to fundamentally change the way they think and do things. The best will manage it but most will not and will continue to push back. Forty years ago some pilots did exactly the same thing but with new people coming into jobs each year and the ‘old and bold’ timing out, change happened and it will happen again. It may take years but we must try for significant improvement whilst those years pass.

Of course the world’s airlines had the benefit of some of the biggest carriers leading the charge and doing the heavy lifting. Companies like United, SAS, Lufthansa and others began to work out the changes needed and the regulator, in the shape of government (FAA, CAA, EASA et al) then converted those into ‘rules’.

That of course meant that while the airline industry had some early adopters there were ostensibly no laggards as the ‘less convinced’ were given no choice. Perhaps that is a model for hospitals and healthcare? In addition, the academies, airline universities and teaching facilities also had to toe the line. To a great extent they did, though many ‘qualified’ pilots still require some training on reaching their first carrier so the training process can always be improved.

So the challenge to the healthcare community is to design a safe(r) system of operation, for both patients and staff, then continuously improve it until it closes on the record of the airlines.