Friday, July 19, 2013

Ah, for astonishingly safe!

While there are differences between airline travel and the provision of health care, the one has a lot to teach the other.  Note this interview of Patrick Smith in the New York Times.  Read this description and imagine if the same things were in place throughout the health care system.

Q. You say air travel today is astonishingly safe. Why?
A. We’ve engineered away what used to be the most common causes of catastrophic crashes. First, there’s better crew training. You no longer have that strict hierarchical culture in the cockpit, where the captain was king and everyone blindly followed his orders. It’s team oriented nowadays. We draw resources in from the cabin crew, people on the ground, our dispatchers, our meteorologists, so everyone’s working together to ensure safety. 

The modernization of the cockpit in terms of materials and technology has eliminated some of the causes for accidents we saw in the ’70s into the ’80s. And the collaborative efforts between airlines, pilot groups and regulators like the Federal Aviation Administration and the International Civil Aviation Organization, a global oversight entity, have gone a long way to improving safety on a global level. 

To bring this home:  Poorly designed systems, poorly functioning teams, and work-around laden work flows, aided and abetted by inadequate reporting of adverse events and near misses, kill the equivalent of a 727 jetliner full of passengers every day in America's hospitals.  If this happened for three days in a row in the airline industry, we'd shut down the airports and ground the flights until we figured out what went wrong and how to fix it.

If airlines are astonishingly safe, as suggested by Mr. Smith, hospitals are astonishingly dangerous.  I don't want to believe that the difference is the case because pilots have an additional incentive in that they go down with the ship.  I want to believe that doctors simply don't understand that their pledge to do no harm is not being fulfilled.


Anonymous said...

I will never forget the reaction of a retired neurosurgeon when I mentioned the recent wrong-side brain surgery case to him: "It has happened before, and it will happen again. The techs put the x-rays up backwards." With a what-can-you-do shrug.
Except for a few enlightened souls (whose numbers are thankfully increasing, but slowly), physicians almost uniformly distinguish between errors they themselves made vs. errors that the system made or 'caused them to make'. If it is the latter, they do not feel responsible and worse, feel it is someone else's job to fix.
This is in my generation; hopefully we can 'educate the young' as Dr. Mayer of Medstar says. But we are educating using the few enlightened souls; it is not enough.

nonlocal MD

nonlocal MD

Anonymous said...

Sadly true (editorial and comment)... I believe no accountability for kings and queens plays a role, plus bad doctors are everywhere as well: excellence in medicine (or in any profession) does not correlate linearly with professionalism. This is true regardless of generation of origin

an MD, of a different generation maybe?

Bart Windrum said...

And as I wrote up in the Journal of Participatory Medicine, it's time to include medical error in these top ten causes of death charts that pop up from time to time in medicine and academia (kind of like Marilyn iconography). The data's out there, it needs to be corelated and the appropriately astericked legend included to account for the data's vagaries—which, in any case, do not overcome the 1, or 2, jumbo jets' worth of lives daily. Article at