Absolute certainty is rare in the NHS, so the service, the public and politicians should show the maturity seen in other industries in response to unexpected concerns, writes Na’eem Ahmed
Fire services were called to Boston airport in January when smoke was detected in the cockpit of the much-feted 787 Dreamliner. In the same month a similar fault forced pilots from Japan to make an emergency landing. That evening the US Federal Aviation Administration (FAA) grounded all US 787 planes, shortly followed by similar directives from Europe, India and Japan.
‘Knee‐jerk localism prevails over a wider commitment to enhance public understanding of decisions made on issues of safety’
The FAA issued an “emergency airworthiness directive”, a requirement to cease all operations to address what was thought to be an overheating problem caused by the novel use of rechargeable lithium-ion batteries, which, alongside its lightweight body and aerodynamic design, would deliver a 20 per cent reduction in fuel consumption. The administration went on to announce a comprehensive review “of the 787’s critical systems with the possibility of further action pending new data and information”.
Despite the inevitable costs of the grounding of all the planes (Boeing’s share price dropped by 3.4 per cent on the day of the incident) and the subsequent possibility of a lengthy review, Boeing president and CEO said in his initial statement: “We will be taking every necessary step in the coming days to assure our customers and the traveling public of the 787’s safety and to return the aeroplanes to service.” Remarkably, despite the disruption to service there was little public opposition to the decisions that were taken.
The aviation industry showed its qualities that enable it to maintain an excellent safety record: deference to expertise during an emergency, good communications between operators and managers, an effective incidence reporting culture and prompt analysis of accidents and near misses.
Valuing patient safety
In the shadow of the Francis report, NHS England medical director Sir Bruce Keogh recommended suspension of child heart surgery at Leeds General Infirmary. He acted on a smouldering gun, on data the hospital had provided and concerns from professional colleagues. Despite this, it appears the public perception of action in Leeds remains mixed.
There are a number of lessons here for NHS England. In the case of the aviation industry, little resistance was shown from airline carriers to the grounding of flights; deferring to assigned colleagues or dedicated bodies in the case of emergencies ensures they can contain problems if they occur.
‘Perfection paralysis should not grip us in an intricate system where absolute certainty is rare’
We need greater maturity in response to unexpected concerns in the NHS. Presently, knee‐jerk localism prevails over a wider commitment to enhance public understanding of decisions made on issues of safety. The culture in the NHS needs to change to allow open reporting and support for precautionary suspension of work on safety grounds. Management, politicians and frontline staff should agree to value patient safety as more important than all other organisational objectives.
The public should be reassured by the action at Leeds General Infirmary, involving complex paediatric heart surgery, as it was important for clinical leaders to be determined in their decision making on safety concerns despite the consequences. Political grandstanding and some public opposition to the decision crept in from the detection of a lack of consensus on the quality of data, highlighting the need for data to be refined.
The communication of the “bigger picture” to everyone, including staff, politicians and the public, needs to be coherent, unified and immediate. Perfection paralysis should not grip us in an intricate system where absolute certainty is rare.
Na’eem Ahmed is a clinical fellow at Faculty of Medical Leadership and Management, Naeem.firstname.lastname@example.org