Safety in aviation has often been compared to safety in healthcare. (1) This is the result of significant achievements in the field of aviation as it pertains to both safety and quality improvement. Despite the number of worldwide flight hours doubling over the past 20 years, the number of fatalities has fallen from approximately 450 to 250 per year. This stands in comparison to healthcare, where in the United States alone there are an estimated 200,000 preventable medical deaths every year, which amounts to the equivalent of almost three fatal airline crashes per day. (1)
As airline pilot Chesley Sullenberger noted, “if such a level of fatalities was to happen in aviation, airlines would stop flying, airports would close, there would be congressional hearings and there would be a presidential commission. No one would be allowed to fly until the problem had been solved.” (2)
Benchmarking – the process of comparing an organization’s processes to best practices from other businesses or industries – is a powerful way to gain insights that can lead to improved performance. (3) There are many best practices in aviation that can be applied to the healthcare setting: for instance, the checklist approach, safety risk management, and the utilization of technology to track trends and foster clear communication.
Safety Lessons Healthcare Can Learn from Aviation
The extensive improvements in safety outcomes within the aviation industry over the past few decades have largely been attributed to the implementation of more efficient safety protocols, including increased tracking and reporting of safety incidents.
According to a 2018 study, “while North American commercial aviation currently enjoys a tremendous safety record, it was not always this way. A spike of accidents in 1973 caused 3214 aviation-related fatalities. Over the past 20 years, the rate of fatal accidents per million flights fell by a factor of five, while air traffic increased by more than 86%. There have been no fatalities on a U.S. carrier for over 12 years.” (4)
How did the aviation industry achieve such vast improvements in safety, and what lessons can the healthcare industry takeaway? There are a few key points to consider:
The Checklist ApproachThe checklist approach has the same potential to save lives and prevent morbidity in healthcare that it has in aviation by ensuring that simple standards are applied for every patient, every time. (6)
Perhaps most notably, the checklist approach has been championed in aviation as a method to improve safety and reduce risk. When it is time to prepare for a flight, pilots use a multi-step checklist to confirm that the flight course, weather patterns, radio set-up, special runway information, etc. have all been taken into account to ensure the safest flight possible. (5)
An 8-week study of John Hopkins Hospital’s surgical intensive care unit (ICU) demonstrated an improvement in the care team’s understanding of patient care plans from 10% to 95% by using a daily goals checklist. As a result of this improved understanding of the plan of care, they were able to reduce length of stay by 50%, from 2.2 days to 1.1 days. (7)
- Risk Management
The aviation industry places heightened focus on ways to address risks through crew resource management (CRM) and threat and error management (TEM). (4) Both strategies are aimed at minimizing risk and optimizing safety.
Crew resource management (CRM) is the effective use of all available resources for flight crew personnel to assure a safe and efficient operation. (8) Threat and error management (TEM) is an overarching safety management approach that assumes that pilots will naturally make mistakes and encounter risky situations during flight operations. Rather than try to avoid these threats and errors, its primary focus is on teaching pilots to manage these issues, so they do not impair safety. (9)
The same concepts can be applied to healthcare risk management. Rather than trying to avoid errors altogether, it can be helpful for leadership teams to recognize that mistakes happen and attempt foster a safety culture that focuses on learning, not blame.
Utilization of Technology
The advancement of technology in aviation cannot be understated when it comes to improving safety outcomes. Beyond the industry’s technological improvements in equipment and aircraft design, significant strides have also been made in the way of incident reporting technology. Such technology allows aviation teams to report incidents, events, and near misses, such as equipment malfunction, unexpected adverse weather conditions, or loss of situational awareness by the flight crew. (10) Tracking these types of safety events over time allows risk management teams to identify areas of concern and put action plans into place for lasting improvement.
The healthcare industry can also benefit from improved incident reporting. Utilizing an incident reporting software instead of tracking events on paper or Excel can help healthcare organizations take a smarter approach towards identifying and addressing risk. Electronic reporting tools make it easy to capture data through desktop, tablet, or mobile devices, while helping leadership teams identify areas of concern. An effective reporting system should make it easy for supervisors to alert the appropriate team members for follow-up action and identify areas for improvement in real-time.
Additionally, a software solution with customizable dashboards and analytics can help healthcare organizations track trends over time and establish action plans to prevent harmful events before they occur.
By looking to the aviation industry as a guide, healthcare organizations can incorporate a culture of safety into their operations and get closer to zero harm.
Performance Health Partner’s Solutions
Implementing an incident reporting software is an integral part of improving safety outcomes in healthcare. With Performance Health Partner’s Solutions, healthcare organizations can easily report, track, and trend incidents to improve outcomes and minimize harm.
2. Sullenberger, C, Chesley, B. ‘Sully’ Sullenberger: making safety a core business function. Healthc Financ Manage 2013; 67: 50–54.
7. Pronovost P, Berenholtz S, Dorman T, Lipsett PA, Simmonds T, Haraden C. (2003) Improving communication in the ICU using daily goals. J Crit Care. 18:71-75.