Patient safety is harder than aviation safety @DocComLtd @drsilenzi

By Jeff Terry
Jun 9, 2012 http://nextlevel.gehealthcare.com/quality-safety/medical-errors/patient-safety-is-harder-than-aviation-safety.php

And five practices to borrow from aviation. Please spare me the oversimplified comparisons between aviation safety and patient safety. I say “oversimplified” because healthcare is harder than aviation. As such, improving patient safety is harder and will require more effort. Don’t get me wrong. We should draw inspiration and lessons from aviation’s journey. After all, aviation reduced deaths per million passenger miles from 5 in 1965 to 0.0003 in 2009. Wow. That’s incredible. The risk, however, is that by overemphasizing the parallels we underestimate the difficulty of patient safety. When we do, we create unrealistic expectations that distract from the real work of understanding and reducing the risks of patient harm.1Why is patient safety harder? You be the judge:

  1. On any given day in the United States, there are about 800,000 inpatients and many more outpatients. By contrast there are about 30,000 flights per day.
  2. The major US airlines fly about 25 different types of planes. By contrast, the ICD-10 lists 12,420 diseases. Each plane, like each disease, requires different protocols to manage.
  3. There are 2.5M nurses compared to 200,000 pilots.

Still, it’s hard to ignore the success of aviation. Particularly remarkable is that between 1990 and 2010, aviation became not only much more safe, but also much more efficient. We’re after the same improvement. With that in mind, here are five aviation practices worth embracing in our world:

  1. Focus on usability. Aviation used Commercial Aviation Safety Teams to improve the usability and safety of things like cockpits. This has great applicability in healthcare and there is a movement afoot, led by Peter Pronovost, to do the same for medical devices.2
  2. Make it safe to talk about events. Aviation led with ASRS. Healthcare has followed with Patient Safety Organizations. Hopefully PSOs will fulfill their potential and unleash a torrent of new data about the nuanced roots of error. This will require that PSOs become functional and culture change within most healthcare providers.
  3. Crew Resource Management.
  4. Simulation. Captain Sullenberger was able to land his plane in the Hudson for many reasons. One of those was that he had practiced landing a plane down in the water dozens of times in the simulator. Simulation is spreading in healthcare for everything from warm-ups, to surgeon training, to crew training to credentialing. That’s a good thing.
  5. Prediction. Aviation has gotten better and better at predicting air traffic.

Healthcare is beginning to do the same. This bodes well for safety as surveillance capabilities begin to anticipate specific procedures, patients, time period and units when there may be elevated risk of harm.

For my part, you’ll see me push to bring practices from aviation to healthcare that can improve safety. But, please spare me the comparisons. We get it. Aviation has done great work. Healthcare is harder.

1. http://www3.ntsb.gov/aviation/table5.htm
2. Reducing Health Care Hazards: Lessons From The Commercial Aviation Safety Team, Pronovost et al, Health Affairs 28, no. 3 (2009): w479-w489 (published online7 April 2009; 10.1377/hlthaff.28.3.w479)

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