Monday, February 18, 2013

The best year since 1945

A new report reveals that 2012 was the safest year in air travel since 1945.

I'm not quite sure what accounted for such good performance in 1945, but the report notes that 2012 was even better than 2011, the previous best year since 1945.

An industry expert and observer, Manoj Patankar, says:

Airline safety has been improving in North America, Europe, and Asia as a result of a number of coordinated efforts on the part of international organizations and national regulatory authorities, as well as voluntary safety programs adopted by air carriers and repair stations. The emphasis in safety improvements has shifted from technical improvements to systemic improvements in organizational safety culture.

But Sully reminds us:

“It’s important not to define safety as the absence of accidents,” said Chesley B. Sullenberger III, the US Airways pilot who became a hero when he landed an Airbus A320 in the Hudson River in January 2009 after both engines lost power. All 155 aboard escaped.

“When we’ve been through a very safe period, it is easy to think it’s because we are doing everything right,” he said. “But it may be that we are doing some things right, but not everything. We can’t relax.”

Many doctors and hospital administrators disagree when suggestions are made that there can be parallels between health care and air transport, or between health care and manufacturing, or between health care and virtually any other field of endeavor.  They are wrong.  Those of us who have been involved in quality and safety improvement know that there is much to be learned from other fields.

The big difference to date between health care and other fields is the lack of acceptance by the medical community of Sully's last point:  "We can't relax."  We are too quick to claim victory, or even progress, in the reduction of patient harm.  I made this point last week in my post about central line infections.  With the national and state focus on cost reduction, we are in danger of having a skewed perspective about what matters.

What matters is redesigning the work in hospitals to help avoid the systemic problems that cause harm to patients.  On this front, we are deficient.  The hospitals that have done the best in this area are usually the most modest about their progress.  They are the first to admit that so much more needs to be done even in their own facilities.  The hospitals that have not yet addressed the issue are suffering from a dramatic failure of leadership--from their boards, their administrators, and their clinicians.  If the airlines killed as many people in their care, they would be shut down within days.


Unknown said...

The airline industry has worked for decades to remove the mystique surrounding the Captain of the plane... S/he is now considered the point-person for the crew, but not the most important member. Each crew member has a voice in identifying and solving problems before they escalate.

Compare this to many health care organizations and I think its pretty safe to say that we have a long way to go for that level of teamwork. Every member of the care team is able to identify issues, from a registrar to a nurse to the physicians, but we will continue to see unnecessary errors until each of these members is given a voice in the process.

Anonymous said...

The airline industry has worked for decades to improve the culture in the cockpit. The captain is no longer the infallible, unapproachable god of the plane. Each crew member has a voice in identifying and preventing errors on each flight...

Compare this to the healthcare industry and you can see that we have a long, long way to go in many organizations. Each member of the care team, from registrar to nurse to physician lends a different perspective to the patient's care. Each perspectives presents a different vantage point to view the process, and an opportunity to identify and prevent errors. We will continue to have unacceptable errors until we create a culture in which each team member is encouraged and rewarded for lending their voice to the care of patients.

Unknown said...

Paul, if you're probably aware of Gary Klein and associates' Naturalistic Decision Making work. Has much to offer the work done in hospital settings, including, but not limited to, surgery. ...mark

Paul Levy said...


Peter said...

You're absolutely correct. Boards who ignore this stuff, CEO's who are then diverted elsewhere beget a culture among employees where the minimum is confused for excellence, and silence is a disguise for ignorance. It is rarely an issue of "caring", it's just the way things have always been.