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While patient care and airlines may seem worlds apart, aviation industrytechniques in health care was the focus of a recent national risk managementand patient safety conference hosted by The Risk Management and Patient SafetyInstitute (RM&PSI).
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The April conference, titled On the Wings to Patient Safety: InnovativeSolutions and Tools, featured two days of seminars hosted by experts in bothaviation and health care.
"Aviation has a lot it can teach the health care risk management andpatient safety community," said Karol Wareck, group vice president of TheRM&PSI. "Health care has grown extremely fast in the last 50 years in terms oftechnology, access and information - but safety has not always kept pace withthe growth. We know the experience of aviation offers some importantparallels and critical lessons in terms of what they have done to reduce riskduring their own exponential growth."
As commercial aviation was getting off the ground and into the mainstreamin the 1950s, health care delivery was relatively low-tech. Other thanpenicillin and a handful of other medicines and herbal supplements, there werevery few manufactured pharmaceuticals. There were also very few clinicalspecialists, limited surgical options and no pure health insurance companies.
At the same time, aviation was booming. As the number of passengers andplanes in the skies grew, safety became a driving force behind innovation andprocess change. As a result, commercial flight is one of the safest modes oftransportation today.
Wareck points to a number of key variables affecting medicine and patientsafety today that didn't exist decades ago, including: increasedspecialization among physicians; the proliferation of medication and, with it,more potential for adverse reactions; major technological advances; and therise of the third-party payer, beginning with the creation of Medicaid in1965.
The RM&PSI conference featured a number of leading voices who shared theirinsights into important patient safety issues and techniques, includingveteran NASA astronaut and national patient safety expert Dr. James Bagian,and Steven J. Hopson, the first deaf pilot to become instrument-rated.
One of the most important parallels for health care from aviation is theuse of simulation and ongoing training. Experts note that simulation is oneof the best tools available to improve safety and the delivery of care, but itstill rarely employed by today's health care institutions.
Another proven technique is the concept of "high-reliabilityunderstanding" - knowing the "why" of human mistakes.
The similarities across both industries are clear: pilots andresidents/physicians are both required to work long hours, performing complextasks with limited sleep and breaks. Another factor is communication withinthe hierarchal structure that is modern medicine. In health care, "hand-offs"in communication can lead to errors. Aviation faced similar issues in itsearly years, but worked to flatten organizations and implement closed-loopcommunication principals, to the point where even a subordinate can direct aleader on what to do.
The aviation industry created its systems with safety at the forefront,implementing fail-safes and stop-gaps that don't depend on human memory. Mostimportantly, they've stopped the "blame game," and instead examine how thesystems in place are enabling mistakes.
Wareck believes health care can do the same. "Change on this level isnever easy, but we are seeing more health care leaders engage in thisdiscussion and embrace new safety processes as priorities," said Wareck. "Weknow it can be done and must now work
