Is the Aviation Model Overplayed in Healthcare?

On August 5, the Sorry Works! Blog and linked in posted an offering asking “Aviation and Medical Errors…This Hand Being Overplayed?” The author, wrote that, “I seriously wonder if the whole approach of comparing/contrasting aviation safety versus medical safety is being overplayed and will have detrimental consequences? I worry how many docs and nurses are tired of hearing how wonderful pilots are and become jaded or resistant to all patient safety initiatives?…

These different fields are dealing with different “input.”

When “Sully” entered a cockpit he was always taking control of a ship that was expertly maintained by highly skilled mechanics. When a doctor gets a patient in his/her care, the ship isn’t always in the greatest shape because the mechanics – us – don’t eat right, don’t exercise enough, smoke and drink too much, don’t listen to doctor’s orders, etc, etc. I recently got myself into trouble with some patient safety advocates by suggesting there are “bad patients” and “bad families.” Never mind that these same patient safety advocates freely labeled doctors and nurses as “bad,” “sloppy,” “arrogant,” etc…how dare I say some patients and families are not so good?!? Again, medicine has different “input” versus aviation.

There is also more variability. Sully flew the same type of plane every time…an ER doc should be so fortunate.” This is a typical argument that we have addressed in our book Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety.

Many people commented on this post, including one nurse who wrote, with visible pique,” I, for one, am getting tired of the Captain Sully’s and the John Nance’s telling us how health care should be like aviation. It’s not. Yes, we have a long way to go in patient safety and checklists have made a difference in some situations. Yes, we can learn from other industries. But aviators need to respect the differences and the greater variability inherent in the medical system, get off their overpaid public speaking soapboxes, and get back in their cockpits.”

A much more measured and thoughtful response came from Marc Edwards, President and CEO of QA to QI Patient Safety Organization, who astutely noted that, Healthcare has yet to fully embrace the major innovation that drove dramatic progress in aviation safety: non-punitive event reporting and analysis. That is the point. The hand is not being overplayed: Non-punitive response to error has for 6 years running been the lowest scoring domain on the AHRQ Survey of Hospital Safety Culture – an abysmal 44% positive.

I wanted to post the response I put on linked in here.

As someone who has observed healthcare for almost 30 years, it is crystal clear that the “hand” of aviation safety is not merely NOT being overplayed, it is hardly being played at all. In our book Beyond the Checklist: What Else Health Care Can Learn from Aviation Teamwork and Safety (, pilot Patrick Mendenhall and medical educator Bonnie Blair O’Connor explain why this hand is hardly being played at all. Most people in healthcare, including many who comment here, completely misunderstand the lessons of aviation safety. They somehow construe that people are adivsing docs, nurses, etc to learn to fly airplanes. What the aviation safety model (ASM) teaches is how to communicate in stressful situations, how to deal with toxic hierarchies, how to manage stressful workloads, how to build genuine teams on which those on the so-called bottom are taught to speak to those on the so-called top of the ladder, as well as how leaders can lead rather than order about etc. Are these not lessons anyone in health care can and should learn? The output( i.e. healthcare vs landing a plane) is not the issue, the process is.

The fact that people who work in healthcare are flying the patient equivalent of broken planes (i.e. sick patients) only makes learning all of this more important, not less. One of the barriers to patient safety is an attitude that argues that those in healthcare don’t have anything to learn from other industries because healthcare is so so different. Of course it is. That’s not the point. We all can learn from safety methodology no matter where it originates or in what setting it is successfully utilized. When I hear healthcare professionals insist that the aviation model is not relevant to healthcare because healthcare is so much more complex, I worry about the implicit competitiveness here. I don’t want to speak for Captain Sullenberger, who was kind enough to write the foreword for our book, but I think I am safe in saying that the first thought that entered his mind in the 3 minutes and 28 seconds he had to land his plane in the Hudson was not, “Oh, God, this could be so much worse. I could be a neurosurgeon.’

When recommending learning from the aviation safety model, no one is saying that pilots and flight attendants are so much better than physicians or nurses. They are not, which is why they are trained in safety methodologies over and over again throughout their entire careers. This recurrent teaching reminds them and us that they are fallible human beings who can and do make mistakes and thus need to learn everything they can in order to keep everyone safe.

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