Flying Safely in Hospitals

How safe do you feel when you fly? Are you one of the white knuckle brigade? Do you have a personal sedative regime? Or are you able to kick back, relax and sift through the plethora of movies you’d only burn your retinas with when strapped in an airborne metal tube?

Whatever your personal phobias most passengers can see the efforts taken to ensure a safe flying experience. Which flyer doesn’t know by now that you leave the kids to flail for oxygen for a bit and look after yourself first after witnessing the all-too-familiar safety demo? Behind the choreographed routine that can be put to good use in a nightclub, there’s a really serious attitude to safety. It’s an attitude that people in health often point to as an example that they follow. Well, I work with aviators and next time you hear anyone say they’ve learnt all the lessons from aviation, put your wallet away before they try to sell you a large architectural landmark on the harbour.

Cruise Control on the Wards

Mistakes in hospitals aren’t just fodder for the tragically inept inhabitants of a medical soap. They are a very serious business. This week, NPR covered a recent publication from the Journal of Patient Safety (and thanks to @MelissaLDavey for that one) revising estimates of the number of deaths that mistakes in hospitals contribute to in the US – the study suggests it may be between 210000-440000 each year (previous estimates dating back to 1998 had it at 98000). If accurate, medical mistakes would be the 3rd most common cause of death in the US – behind only heart disease and cancer. It’s the equivalent of more than two Airbus A380 airliners plunging from the skies every day across the US.

It’s a matter for Australian hospitals as well. Improving safety would be one of the most effective ways of improving health outcomes from hospital care. Focus has been placed on this and aviation safety practices all too frequently get trotted out as inspiration. The problem with this isn’t that aviation practice isn’t worth modelling. The thing is that aviation safety is a comprehensive program. All too often, those working on the hospital safety blanket are taking a couple of patches from the flight experience and hoping that’ll cover enough of the old holes and make it just pretty enough.

The Whole System

All too often in my experience in healthcare people refer to lessons from aviation when talking about individual elements. They’ll trumpet simulation “like pilots do”. Or they’ll mention “managing resources” like in an aviation emergency. It plays like someone has decided to “Like” the Air Crash Investigations Facebook page and glean what they can from the conversation.

What we should learn from aviation is that you can’t just do 50% of the job. Aviation as an industry started wrestling with the problem decades ago and has evolved a system that looks across the whole set-up.

Here’s the quick version – initially the assumption was that crashes happened because technology messed up, or individuals made mistakes. Over time it became apparent that you couldn’t address issues in an isolated fashion. You need to look at every step of the chain.

So aviation safety doesn’t just focus on the way the aircraft is built or the maintenance. It doesn’t stop with the crew training and simulation. It looks at skills maintenance, communication patterns between crew members of all levels, personal and interpersonal factors affecting how the crew responds and individual thought processing in crises. And it looks beyond the flight. It looks at control systems and industrial pressures that might influence how crew members respond in any situation. It goes on and on.

The key thing is that it is taken seriously. The time and effort make this clear.

Safety At The Frontline Needs People In The Background

This is where health systems have a long way to go, and where they can’t even be classed as “Aviation-Lite”. Now, clever bloggers include things like graphs with equations and stuff. This blog has been remiss in not providing graphs so I’ve tried to address this flaw.

This graph absolutely doesn't reflect a reality where safety has received steady resources and resulted in increased awesomeness. [via]

This graph absolutely doesn’t reflect a reality where safety has received steady resources and resulted in increased awesomeness. [via]

Hospital safety has not received steady and unrelenting support. I couldn’t find a graph that properly depicted the concept of “piecemeal”.

All too often what we see is isolated initiatives. So we hear that someone is now doing simulation training. But the simulation training doesn’t incorporate whole teams that actually work together. Or comprehensive communication training so all team members feel free to contribute. Or even repetition of the scenario training on a regular basis.

Or we introduce safer working hours without extra staff to make sure adequate senior cover is part of those hours. Then we forget to train everyone as to how to conduct handover in a fashion that will minimise vital information being missed.

What is most likely the case is that those interested in hospital safety understand how comprehensive the approach should be, but don’t get the backup to do it. Because safety is just another example where the frontline staff, like the aviation crew, need support behind the scenes.

This is not a novel idea and has been eloquently addressed in slightly different settings by Prof Tarun Weeramanthri writing for Croakey and the excellent Julie Leask.  Denigrating anyone who isn’t part of the “frontline” is a popular chant for politicians at the moment. You can see a recent version of this “no frontline cuts” mantra from the new federal health minister here. No doubt some bureaucracy is worthy of review but people with clipboards actually matter. Each time a bureaucrat is axed, it’s just possible a public health fairy loses its wings.

There are people trying to address hospital safety and they’re not just the ones wearing stethoscopes or uniforms. They need proper resources to address this little thing that’s been identified as the 3rd biggest killer in the US. Without taking it seriously enough, the hospital version of aviation is going to look an awful lot like a movie they won’t show on a plane – Flying High. 


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