Taking a Page from Airlines’ Safety Playbook

I am writing this post 37,000 feet over Nebraska, returning home from a conference in California on Sunday. 

Before you comment about the jet-setting life of a hospital CEO, let me point out that I left two days ago, sat in meetings for ten hours each day, and I cannot watch or listen to the Super Bowl in this plane.

But the time made me reflect on something my friend Dr. Bob Wachter said in the meeting.  Bob has written a great deal about health care safety, both in a book as well as on his blog, Wachter’s World.

At this weekend’s meeting, he briefly talked about the comparative safety of the U.S. airlines industry versus health care. 

This has been the topic of many papers, books and conferences. It is not a new idea, but it is a bit more immediate when you are sitting in the exit row of a 757. 

Somewhat tongue in cheek, Bob asked the attendees how many passengers died as a result of pilot error on U.S. commercial flights in 2010. The answer: Zero. 

He then asked how many passengers were seriously injured as a result of pilot error this last year. The answer: Probably a few due to hard landings, but not many. 

Then, he asked how many of us knew our pilot’s name, where she went to school, how the pilot was rated on a website, or if we knew the pilot’s last passenger satisfaction survey results.

Now health care is not aviation, but there must be some things to be learned from these observations. 

  • How do we get the most out of health care to be as safe as air travel?
  • How do we get to the point where doctors provide as uniformly reliable and predictable outcomes as pilots?
  • What can we learn from this industry as whole?

Bob ended by saying that the pilot who successfully brought a crippled plane down on the Hudson River without casualties needed to be recertified for maintenance of his flight status eight months after the heroic day. 

He did this in a simulator, just like all other pilots.

Food for thought, now over Iowa.

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7 thoughts on “Taking a Page from Airlines’ Safety Playbook

  1. Dr. Popovich, I want to tell you first how much I appreciated the time you spent with the EAG (Employee Advisory Group) at HFH last month. In case you didn’t notice everyone in the room was following every word you said. You were wonderful. The talk of bringing back the “family concept with co-workers” and the identity of the “Main Campus” was pure joy. We (the EAG) will assist you in any way we can (because We Can)!

    Your Doc in the D is wonderful. You are a believer and you have a great sense of humor. Very refreshing!

  2. Glad that your flight ended safely.

    There are a few books out that speak of this very nature:

    Why Hospitals Should Fly by John Nance
    Checklist Manifesto by Atul Gawande

    Both point out how healthcare can perform better through standardized work.

  3. How do we get to the point where doctors provide as uniformly reliable and predictable outcomes as pilots? Is that even possible? We should always strive to be as excellent in our care delivery as possible, but we’re dealing with unpredictable human beings, not machinery. I think the ending of your essay says it all. Sully recertifed on a simulator. Yes, we can program simulated patient care situations for practice use, but there will ALWAYS be the handful of patients who don’t respond as the computer model predicts.

  4. These are excellent thoughts and encouraging for healthcare. Yes, ZERO is a reachable goal, as in zero hospital acquired infections.
    Years ago I came across an article by FC Spencer that still inspires me today. He draws the same conclusions as your friend Bob did. I highly recommend it and then of course Dr. Gawande’s books….

    Spencer FC, Human error in hospitals and industrial accidents: current concepts.
    J Am Coll Surg. 2000 Oct;191(4):410-8.

    ….Several concepts have emerged. First, errors are not character defects to be treated by the classic approach of discipline and education, but are byproducts of normal thinking that occur frequently. Second, major accidents are rarely causedby a single error; instead, they are often a combination of chronic system errors, termed latent errors. Identifying and correcting these latent errors should be the principal focus for corrective planning rather than searching for an individual culprit. This nonpunitive concept of errors is a key basis for an effective reporting system……

  5. Dr. Popovich,
    I enjoy your “Doc in the D”, it is inspirational! I agree about taking pages out of the other industries and make the health care as safe as possible. Although the long journey lies ahead, one has to start somewhere. While temptation to chase the success of others is rampant, balanced caution is vital. As being the leader of one of the greatest hospital in the country and vast experience in taking patient care at the heart, you are one of the few whose “Blink” response would have higher probability in making difference in the process of care improvement. So, make a call and we (all HFHS colleagues) are with you.

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