Can medicine learn from aviation?
 

Hi, I hope this is right forum...

I'm interested in the views of aviation experts about what medicine/ healthcare can learn from aviation in order to improve patient safety.

Thanks DH

A number of threads have canvassed this topic and there are various publications in the public domain on similar matters. Suggest a search both in PPRuNe and on the net, generally. If you are in the field, then your professional sources should have many references.

Yes, I think it can. I would add the use of checklists in the operating room and duty time and rest limits.

Good lord, I hope not.

dochealth as a Pu I do not consider myself an aviation expert. As a registered nurse qualified for many years I do not consider myself a healthcare expert either. I do however have insight into both fields :ok:

Medicine and aviation are very simular in their application to safety of the "service users". We both do an excellent job......most of the time.

We could both however be a little more proactive. In the NHS we "learn lessons" as a result of something nasty happening and we then change policies and procedures. In aviation we do the same.

beachbumflyer we do have checklists in the OR...swab counts,instrument counts and they are the minimum. My duty period as an RN are below what they are for a Pilot yet we both potentially hold lives in our hands.

Maybe aviation could learn from medicine here? :hmm:

Do doctors and nurses have regular, rigorous proficiency checks like pilots and air traffic controllers? It has always baffled me how doctors retain such a huge amount of information in their heads - considerably more than I had to as a controller.

I suspect Aidan Hallighan at the DoH is your man.

Rene Alemberti (France) and Chappell, Weigmann, Merritt and others (US) have expanded their investigations of human decision making/error management from aviation to medicine.
If you need specific citations, drop me a PM and I'll see what I can do.
J.

Difference between a Doctor and an Airline Pilot?

Doctors can kill thier patients one at a time.

Airline pilots can Kill 100's at a time :}

Try this -

Clinical Human Factors Group (CHFG)

flipster

I have long been interested in this topic. Here in the states, I know of a few firms that are trying to institute SMS’s into the medical field using proven aviation safety programs.

I have more than a passing interest in this subject. I recently entered a hospital after a fall off my bike for a hip replacement. I was put in a virtual coma for 12 days due to prescription drug interactions. I obtained my full medical record and was appalled at the lack of procedure, oversight, etc., that we have all become accustomed to in the aviation world.

Climb into the cockpit of (for example) a B-757 anywhere in the free world, and it will be operated in essentially the same manner.

At least in the U.S., enter a hospital, and you have entered the world of fiefdoms. Every one has different procedures, protocols, and quality of care.
Safety is cost effective in aviation....it would be in medicine also.

HeathrowDirector good question re the checks. The answer is basically our checks are nowhere near as vigourous as those of a Pilot....and they should be.

Senior Surgeons have to submit their mortality stats on a regular basis. If these make for a grim read then Trusts start suspending operations in that field until investigated. Thank God we don't have the same approach in aviation :uhoh:

As for their Senior Physician colleagues and all grades in between I've no idea what pases for clinical supervision. Junior Docs practice their practical procedures on live patients under the supervision of a Registrar. When somebody last checked the Registrars competence I wouldn't know.

For me as a Nurse? Well I have to sign a form every 3 years that says I've completed 450 hours of clinical placements and 35 hours study/training relevant to my field. Nobody ever checks this out....it relies on my integrity.

Shoreguy in the UK at least you would not be allowed to take up a bed for 12 days post op hip replacement. We need the beds and your stay is free over here :ok:

Finances may have made a difference to your experience. If you were a straightforward hip replacement I cannot think of any prescription drugs you would need that would literally keep you on your back and unconscious for 12 days :eek:

Over here you are up on day 2 following post op X ray as we want to clear the bed for the next punter. In the US they may just want your money for a 12 day stay and who knows you may develope a DVT or chest infection that needs treating......:suspect:

As for universal protocols well over here at least we could certainly do better. We could learn from aviation in this respect.

To answer the posters question, they already are.

I was speaking to a chap who is involved in changing current (UK NHS) procedures. He attended a seminar where a former airline captain gave an address explaining the accountability and procedures throughout aviation that are designed to reduce errors. The intoduction of human factors training was also high on the list.

The chap I spoke to was very impressed with the way aviation deals with all aspects of safety awareness and reporting.

It ain't perfect must we must be doing something right. :ok:

lowcostdolly,

My situation was an interaction with meds I was taking and meds administered in the hospital. I gave them my list of meds upon entry, and cautioned them about interactions.

I always thought I could be my own advocate in a hospital setting. I did not count on "being off the planet" during what should have been a simple, normal, three day hospital stay. Privacy (HIPPA) laws cut both ways....my "significant other", who was there the entire time, had no rights or authority.

It is over....now mending well.

Shoreguy

Shore Guy good to hear you are on the mend despite everything :ok:

I Obviously don't know what your admission meds were but it sounds to me that either they should not have been prescribed during your stay or if you cannot do without them then alternative aneathesia and post operative drugs should have been prescribed other than the ones which interacted.

I don't know what US protocols are but over here it is unlikely you would have experienced what you did. Your meds would have undergone the scrutiny of the admitting RN, F1, pharmacist and the aneathetist. We would all be held accountable in some ways. The F1 for prescribing the wrong drugs, the nurse for giving them without querying the prescription and the aneathetist and pharmacist for not noticing a potentially dangerous situation.

If this doesn't happen in the US then I would say that not only could your system learn from aviation it could also learn from us. If it was meant to happen and didn't because the hospital did not follow protocols you may have a case for litigation.

Its been touched on but to emphasise, the major difference is annual licence renewals. In other words a test of competency once a year. Plus and this may also be relevant, an annual medical.

Further debate here... http://www.pprune.org/jet-blast/4094...s-blunder.html

Left or right?
 

Hi Dochealth,

Very interesting thread. Am I right in assuming that surgeons in general look to operate as a cohesive team in a controlled ebvironment? If so, the many lessons of multi-crew interaction (e.g checklist use, briefings, communication loops, allocation of roles, leadership/followership, DODAR & NITS, confirmation baias & error chain avoidance etc...) can be applied to the surgical environment.

I seem to remember recently that a UK hospital was taking some of these aviation learnings and applying to their surgical methodology (sorry havent got the article). After all there are similairites to amputating the wrong leg and shutting down the wrong engine... which has happened in both professions.


PP

That'll be PT seen here a while back on Sky explaining it...........................................

Surgeons To Use Safety Checklist Before NHS Operations To Reduce Deaths And Complications | UK News | Sky News

p.s he's still current as a Captain and off to sunnier climes I'm led to believe

:ok: Well worth a look KYJelly.

That report states there were 179,000 errors made in the NHS in 2007. Do medics also undergo 6 month checks (OPC/LPC) as we do in the aviation industry?


PP

Thanks for that KY.

Makes a change me getting something right on Proon. :O

Can medicine learn from aviation?

Absolutely, positively yes! I had an excellent presentation from Trevor Dale during my MCC course. He is co-founder of a company that helps the healthcare industry learn the techniques that the airlines have been mastering for decades. Read the following for more:
Atrainability Human Factors Training Critical Team Performance Heathcare Aviation Customer Services

Of course, aviation can learn from medicine also i.e. having both a regulator and a trade union who ensure access to their industry is based purely on academic ability and not on financial ability, the end result being a very high standard of entrant and protected attractive terms and conditions of employment, which then attract the next generation of highly capable students. Compare this to the commercial pilot industry where access to all the training schemes and the vast majority of jobs is increasingly based on ones ability to hand over huge amounts of money, all for the prospect of a rapidly diminishing return on the costs incurred in getting there.

Without a doubt the greatest concern has to be for the erosion of safety being offered to the paying public both in the here-and-now and in the longer term as the attraction of this industry to those of high aptitude decreases proportionally with the decreasing terms and conditions, and this is before we even consider the problems of finding the skills required from a talent pool ever decreasing in size due to ability to pay.

The next concern is for those who, despite the freefall in potential income, are still attracted to professional flying and do actually manage to get the lucky break into the industry - if not being backed financially by others they are going to find themselves in a position where they are unlikely to be offered a mortgage or, if they are, it is likely to be in a very inhospitable area - cue pissheads and druggies running amok at all hours of the night - not very conducive to a good nights sleep. Add to this the fact that the house price will dictate where the pilots live - meaning a likely huge commute to work - and an ever present battle to meet training loan repayments, mortgage repayments and general life costs, and you are looking at a very tired, stressed, fatigued crew member. Is this what airline accountants and executives, Balpa and the CAA consider to be desirable in the flightdeck? For all my amazement in the leaps and bounds in safety aviation has achieved - most noticeably in the last few decades - I am absolutely gobsmacked that those who are entrusted with its guardianship have sat back fat, dumb and happy as the lessons of the past so painfully learned are kicked under the carpet, and all so shareholders and executives can have more money. What was it Abba sang about money? Ah yes, must be funny in a rich man's world. Well, let's all hope that the s**t doesn't hit the fan as a result of putting all the financial risk onto the future flightdeck........nothing funny about that!

The last concern is for those who never manage to get their lucky break in the flying world. A rejection from medicine school may prove hugely disappointing but it at least allows one to refocus and get on with one's life. Compare that with someone unable to gain a flying position post qualifying. The flight training industry doesn't have the number restriction that the medicine world insists on, the end result being many thousands from across Europe ending up some tens of thousands of pounds in debt with the sad fact that there are nowhere near enough jobs to go round. Now I'm all for competition but when it comes down to those not attaining their dream being left with a crippling debt that will have a monumental effect on the rest of their life, I think that something should be done, namely regulating the numbers that can train. The result would be a higher standard of pilot coming out of the training industry, which can only be a good thing for the all concerned. And for those who don't meet the standard, it protects themselves from themselves and the unscrupulous in the flight training industry. The question is, are the airlines and the aviation authorities going to act any time soon, or are they crossing all their fingers and toes in the hope that cockpit technology, good luck and the Gods will make up for the undeniable decrease in safety that is now upon us.

VC10 Rib22

ps sorry for the length of reply, maybe I should have just wrote 'yes'. :ok:

Can medicine learn from aviation?
 

Just to turn the situation around (and shake it a bit) to see what falls out.
The question is presumptuous. Why should we think that medicine can learn from aviation; is aviation that good, has aviation something to offer?
Exchange of information, yes; similar training / management techniques, maybe; same context, probably not.
James Reason is the oft quoted ‘aviation’ safety guru, but the majority of his work, and for some his most effective work, was in medicine. Thus, perhaps aviation should be learning from medicine (and possibly has, but not necessarily successfully).

Does the assumption that aviation has something to offer to medicine imply that aviation knows about these safety, human factors, and CRM things?
The principles of safety (risk, and risk management) are reasonably common amongst industries.
Human Factors is a wide ranging and nebulous discipline, in which some selectivity in domain or activity is required, e.g. human behaviour.
CRM … … it all depends on how this is defined;
“ CRM is like a bidet – except that everyone knows what it is for, but no one knows what it is.”

If we take a very close look at aviation, can we really identify quantifiable success with HF / CRM training, and if so, how has this been achieved. Then, will the subject aspects and processes transfer to medicine (or vice versa).
Perhaps the training, tools / techniques can be or have already been transferred; … but what about those successes …?

VC10 Rib22 your appraisal of the aviation industry as it stands appears to be a growing concern. See:

http://www.pprune.org/terms-endearme...-aviation.html

Perhaps its not a case of what medicine can learn from aviation but what aviation can learn from medicine in terms of how its industry is managed. There's not doubt both can benefit from the transfer of knowledge from each other and which I think is being facilitated by the likes of Air2Med Consultants and Atrainability.

The principal difference being, however, is the context in which both industries operate within. The UK NHS is a public service with full accountability under one roof and whilst I am sure market forces influence operating procedures it will never be to the same extent of the aviation industry which is fully exposed and fragmented in the private sector.

Commercial constraints are more lethal to the individual operator (possibly an arguement for why we are seeing the rise of P2F schemes) and I dont see the govt rushing to buying any of the airlines in this current climate.

Perhaps the opportunity for Air2Med and Atrainability is to act as a 2 way shuttle and educate the aviation industry as well. They could take NHS learnings about training, selection, recruitment T&Cs and the impact that has on safety?

Dochealth

I came on to this trhead kinda lat at night so I wont write much but the simple answer is yes. I'm a risk manager for a large NHS trust and so I deal with serious untoward incidents.

Drop me a private message and maybe we can get talking. I have long been interested in CRM and its use in hosptial settings. Incident investigation too. I suspect that we have very much to share.

Speak soon

MD