Comparisons with safety in the aviation industry
Robert L Helmreich’s article was published in the BMJ in March 2000. It is entitled “On error management: lessons from aviation”. He argued that aviation errors often cause catastrophic loss of life so cause considerable media attention, whereas a single death is dealt with on an individual basis and without review of the process that led to the fatality. Since then there have been a number of published articles urging the NHS to learn from the aviation industry in order to promote patients’ safety and reduce incidents caused by human error.
In aviation they attempt to minimise the impact of human error as far as possible with back-up procedures, check-lists and CRM (crew resource management) training which has now been made mandatory by the Civil Aviation Authority. This involves a day’s training every year attended by both flight crew and cabin crew (together) focusing on human factors in risk and encouraging an open relationship between all crew members so that cabin crew are not afraid to highlight concerns during a flight. This was, in part, prompted by the Kegworth air crash in 1989 where a catalogue of errors led to a fatal crash. One issue that arose was that the cabin crew were afraid to question the experienced pilot when he turned off the wrong engine as they feared questioning his authority.
Can the same issue not be seen within an operating theatre? How many theatre nurses, or indeed registrars, would be confident enough to question a senior consultant surgeon if they believed he was about to remove the wrong kidney? Can checklists not be introduced to minimise errors? These are all questions that have been raised by medical experts in a number of articles since 2000 but no action seems to have been taken. The NHS do not seem to be learning any lessons and those with the information available to them do not appear to use that information to make changes, instead just settling each case on an individual basis. The NHSLA must have a wealth of information available to them as to repeated errors and systems failures, why is this not being fed back into the system and patients’ safety improved?
A number of articles (stemming from 2000) highlight the comparisons to be drawn between the industries and failures to learn and improve patients’ safety. There seems to have been a new surge in this since November 2008 onwards and the health select committee are apparently carrying out an inquiry into patients’ safety.
> Progressing from rhetoric to results