What Can Health Care Learn From Flight Safety?

Flying Safety, June, 2001 by Ray King

I have been privileged to be a guest in two complex worlds during my Air Force career: Health care and flight operations. Both of these professions demand sustained, high-level performance and both have very high stakes--to include preservation of human life itself!

The medical and flying professions attract some of the most talented individuals around and offer very sophisticated training. How could health care benefit from the experience of flight safety? In the attitude and management of error. Most aviators understand that errors are an integral part of what they do and hence try to manage ("trap") them. When a mishap occurs despite an aviator's best efforts, there's a concerted effort to understand the process and prevent similar mistakes.

Health care, on the other hand, finds itself in the unenviable position of trying to maintain an aura of perfection. With this mindset, recognizing and documenting errors is discouraged. I once witnessed a physician criticizing a nurse because she (the nurse) documented a medication error in a patient's chart. Was the physician in this example a "bad actor"? No. He was coping the best he could under the constraints imposed on him. He was concerned about creating an "audit trail." Part of the problem may be our legal system; to admit mistakes is to lose ground in an adversarial system.

On the other hand, per AFI 91-204, Safety Investigations and Reports, formal safety investigations enjoy privilege: That is, the information gathered is used solely for future aircraft mishap prevention. Under such an arrangement, error can be freely admitted without fear of legal repercussions.

What's the lesson here? Safety, whether in health care or flight operations, is best served when an atmosphere of openness--instead of a culture of blame--exists. To all of you Flight Safety folks out there: Keep up the good work!