Aviation Offers Health Care Some Lessons

July 4, 2008
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LANSING — The health care industry can learn a thing or two or three about patient safety from what might seem an unlikely source: the aviation industry.

Aviation industry techniques applied to health care was the topic of a recent two-day national risk management and patient safety conference hosted by The Risk Management and Patient Safety Institute.

“Health care has grown extremely fast in the last 50 years in terms of technology, access and information, but safety has not always kept pace with the growth,” said Karol Wareck, group vice president of RMPSI, an organization whose goal is to reduce medical errors. “We know the experience of aviation offers some important parallels and critical lessons in terms of what they have done to reduce risk during their own experimental growth.”

The institute held the same conference, entitled “On the Wings to Patient Safety: Innovative Solutions and Tools,” last fall in Traverse City, and the response was so positive that RMPSI decided to offer it again, Wareck said. The conference was repeated in April in both Traverse City and Las Vegas.

Aviation has been a high-tech industry for a long time. When flying went mainstream in the 1950s, health care delivery was still relatively low tech, there were only a handful of manufactured pharmaceuticals on the market, and there were very few clinical specialists, according to RMPSI.

As commercial aviation took off and the number of planes and passengers grew, safety concerns drove innovation. The industry implemented fail-safes and stop-gaps that didn’t depend on human memory, and flying subsequently became one of the safest modes of travel.

Wareck believes health care can achieve a similar level of safety with patients. Both aviation and health care involve teams and high risk in terms of the potential catastrophes that can occur, she pointed out. 

“In the aviation industry, we tend to hear about one catastrophe that results in a lot of deaths, but if you put all of the medical errors together, we know that, from our experience and from the data, the number of deaths in health care exceeds the aviation industry,” Wareck noted.

Medicine today is complex and carries much more risk, Wareck said. Variables affecting patient safety include increased specialization among doctors and the proliferation of pharmaceuticals, over-the-counter drugs and supplemental medicines that, taken individually or together, have the potential to cause adverse reactions. New medical technologies also complicate patient safety. A new technology can offer great advantages, as long as surgeons and their staff have a solid understanding of the technology, know how to use it and know what to do if it doesn’t work properly. Failures at any one of those points can impact the emergency response needed for a given patient.

“It creates another layer of complexity,” Wareck said. “New technologies emerge at such a rapid rate, it’s difficult for health care practitioners to stay abreast of everything.”

The more people who are involved in the delivery of health care, the more opportunities there are for communication — and for communication breakdowns, according to Wareck. Often specialists and other treatment providers involved in a patient’s care don’t have communicating medical records: They all have their own independent records, which may or may not have all of the patient’s information, she said. That creates a lot of potential for communication breakdown, which compromises the health care community’s ability to accurately diagnose in a timely manner and deliver care in a way that optimizes the outcome.

The aviation industry has created a process for team communication that is somewhat methodical and shifts the onus of leadership to each member of the team, depending on the emergency. In aviation, any member of the delivery team can take over and handle an emergency.

Conversely, health care is traditionally hierarchal, and the physician is always the leader. When a subordinate on the health care team knows of something that could impede patient safety, that person needs to be empowered to stop the care delivery process and allow the team to regroup, re-evaluate the situation and make an adjustment, Wareck explained.

If, for example, a patient is about to have surgery and someone on the team recognizes it’s the wrong limb or that there’s a breach in infection control, they need to be able to stop the procedure from going forward. The team should be designed to focus on collaboration, and the health care culture needs to support every member of the team so they’re empowered to speak out and bring pertinent information forward, she said.

“In health care, people are uncomfortable with speaking out because of hierarchal differences,” Wareck said. “As simple as that sounds, it still happens today. We’ve learned that the vast majority of medical errors are a result of the system, the result of complex processes that have broken down.”

Wareck would like to see health care use a lot of simulation in training, as the aviation industry does. Her organization has partnered with another organization to do simulation exercises in the local hospital setting. They use computer prompt simulators to reenact complex medical scenarios and videotape the health care team in action. Afterwards, the team views the video to evaluate how they responded to the various clinical scenarios and observe their own performance and interactions.

“It’s been a very powerful tool to help the health care industry learn and self-discover,” Wareck said. “What we’re finding is that teams that have the right culture and have the right style of communication tend to perform better under pressure. That’s the power of learning we’d like to bring to the health care community.”    

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