news focus: Airline pilots are helping to steer the NHS into a new no-blame culture of team-working and owning up to mistakes. Jennifer Trueland reports

Published: 18/04/2002, Volume II2, No. 5801 Page 18

Captain David Johnson, a pilot with British Airways, describes what he calls a 'eureka moment' at a multidisciplinary course on teamworking in an acute trust.

'A senior cardiothoracic surgeon admitted that he knew he was difficult, that he had a short fuse, particularly in tense moments in theatre, ' he says. 'And he said he knew that he didn't suffer fools gladly.

'One of the theatre nurses who was there started to cry. She had worked with him for years and had never heard him being open like that. During a follow-up workshop some time later, he told us that it had changed his life.'

Captain Johnson is co-owner and founder of Terema, a company trying to bring the NHS in line with the aviation industry, with its emphasis on openness, error reporting and teamwork.

His approach, called 'Sharing the experience', is one of three lines of attack - with the airline models in mind - being taken by the clinical governance support team, part of the Modernisation Agency in England.

Another strand involves a company called Global Air Training, which this month started pilot projects with two trusts in postincident debriefing and errorchain analysis (in other words, looking to see what went wrong).

The third involves promoting the idea of team coaches, to work to enhance teamwork, not only where things are going wrong, but also to support successful teams who want to make changes.

If this sounds a bit touchy-feely and too group-hug for you, then you're probably just the sort of person the programmes are aimed at.As far as senior figures in the Modernisation Agency are concerned, teamwork is not a fluffy concept, nor is it optional.

'We need to change cultures, ' says Howard Arthur, programme director in team resource management and patient safety with the Clinical Governance Support Team. People tend to think that teamworking is just about being nice to each other. It is not nicey nicey, It is about working together and facing challenges as a team.

It is helping people deal with real situations. We know that good teamworking improves outcomes and it also has other positives, like improving recruitment and retention by promoting an awareness in people about the needs of those around them.'

The airline industry began to place huge emphasis on teamworking following a number of disasters attributed to pilot error. In one, an aeroplane sank into the Everglades in Florida as the pilots tried to change a lightbulb. In another, two planes collided on a Tenerife runway because of poor communication with flight control.

The industry already had a mandatory occurrence reporting scheme, introduced in 1976 by the Civil Aviation Authority. But in 1982, it introduced an independent scheme called CHIRP - the confidential human factors incident reporting procedure. Under this, all adverse incidents - including near misses (airprox, in the business) and even safety issues like a passenger or crew member becoming ill - are reported within 96 hours. It is confidential, deidentifies the airline, and is intended to find out what went wrong and try to avoid it in future, rather than to blame individuals.

This led to a change in culture, says Mr Arthur, which began to see the end of the Sir Lancelot Spratts of the aviation world, and herald a new age of equality.

'There are still people in the health service like that, ' he says.

'You know, those who you'd never dare call by their first name. But if someone says, 'Dave, You have cocked up there', I'll say 'thanks', no matter which member of the team it was. There have been times when people have been asked to resign because of poor teamworking, ' he says. 'It is considered very important.'

Since last year, Terema has been working with several directorates in one unnamed trust and plans to start programmes in others soon.

Those leading the courses tend to be working or retired pilots, a fact which Captain Johnson believes makes all the difference.

'Being a pilot bestows credibility, ' he says, admitting that consultants in particular are more likely to listen to someone who is the 'captain of the ship'.

The idea for Terema came to him three years ago, when, jetlagged in the US, he found himself watching a senior doctor talking on a cable television channel about how medicine needed to operate more like the aviation industry. Instead of following his first instinct and turning over to find some cartoons, he was gripped by what was being said.

'I couldn't believe that health services didn't do all the things which were common practice in the airline industry.'

Since he began work with BA predecessor British Overseas Airways Corporation when he was 19, some 34 years ago, he has undergone checks once or twice a year to ensure his continued fitness to fly. 'And now, on route checks, 90 per cent of the assessment is on how you work as a team, ' he says.

Captain Johnson says that bringing his company on board is a difficult decision for trusts to make.

'It is not like buying an anti-cancer machine, when they can immediately say It is saving people's lives.

This is more difficult to assess empirically. But We are not born with team skills. We can develop them and they can be taught.'

HSJ was unable to speak to anyone in the trust most closely involved with Terema. For reasons of 'sensitivity', the Clinical Governance Support Team wouldn't identify it. But Mr Arthur says feedback is positive. 'Some of the reactions have been very hopeful, ' he says. 'Some people who were the most cynical at first have now become strong champions for it.'