Making improvements in medical error: lessons from the aviation industry

While the rate of fatalities in the commercial air industry is 1/3,000,000, the rate of fatal medical errors is 1/300. However dramatic improvements in patient safety have been made by American hospitals through drawing on the lessons of other industries.

Safety in aviation has been transformed in 30 years by four developments that are now being applied to healthcare. First, a national system of reporting incidents, the Aviation Safety Reporting System. Any crew member may report any problem, problem or potential error to an independent agency without fear of punishment. This has created a culture of openness that not only prevents errors but provides a continuous source of data. Second, the roles of everyone involved in flying a plane, from the pilot to the ground crew, has been standardised and set out in clear protocols and checklists. Third, all members of the crew are trained to take responsibility for improving outcomes as part of a team. Finally, the air industry made a commitment to improving safety and shared a belief that every accident and every mistake is avoidable.

These lessons are being put to use with dramatic results in healthcare. While medical errors were once seen as caused by “bad” doctors, shortcomings in health systems offer a better understanding of the mistakes of clinical staff. Rather than punitive systems, many American hospitals are seeking to explain preventable deaths by failures in the processes that surround any given medical intervention.

Standardised protocols are making medicine less intuitive and more precise. “Airline style checklists” have been championed by the Boston based surgeon Atul Gwande and the World Health Organisation  and seen complication rates fall from 11 per cent to 7 per cent in eight cities, while death rates fell by 40 per cent. Surgical clinicians now introduce one another before an operation, creating a stronger team ethos and making supporting clinicians more confident in raising concerns.

By introducing a series of checks one hospital was able to cut catheter infections from 2 per cent to zero in 18 months, when repeated across Michigan 68 hospitals reported no infections over six months. The Institute for Health Improvement championed six safe practices that saved over 100,000 lives. Team work and shared responsibility among all clinicians have been instrumental in cutting medical errors. 

Key to the success of initiatives to improve patient safety is meaningful accountability. In America there is no safety regulator along the lines of the Care Quality Commission. Just like the air industry, healthcare providers have taken the lead in introducing safe practices.