Learning healthcare safety lessons from the aviation industry

There are many safety lessons that healthcare can learn from the aviation industry, the Irish Osteoporosis Society 2023 Annual Medical Conference heard.

Captain Niall Downey, an airline pilot with Aer Lingus, was previously a cardio-thoracic surgery trainee in Dublin and Belfast, but retrained due to a lack of long-term training posts in the late 1990s. In his presentation to the meeting, Captain Downey said he was there to share “how our hugely successful aviation safety model can be translated to healthcare”. His main take-home message was that error is inevitable, “is nothing to be ashamed of,” but that learning from mistakes and putting in place structures to minimise them is key.

He gave examples of errors occuring across all areas of society, even at the highest level.

So what about errors in healthcare? Captain Downey quoted statistics showing that error rates have not improved in 50 years, with figures from the US, UK, and Ireland all confirming an adverse event rate of approximately 10 per cent in hospital inpatient admissions.

The cost of this issue in healthcare in Ireland alone is approximately €2.4 billion per year, 70 per cent of which could be saved, he maintained.

He then highlighted data showing the aviation industry’s 97 per cent improvement in reducing errors over the same 50-year time period.

Explaining how this was achieved, Captain Downey said it was through a “just culture”, and targeting “what went wrong, not who went wrong”.

“A simple philosophy: Where can this go wrong and what’s plan B when it does?”

He acknowledged the minefield that healthcare staff work in compared to the ‘human factors’ approach in aviation, which tries to make it easy to do the right thing, eg, very different drugs with very similar packaging.

Captain Downey said healthcare workers should feel safe in identifying risks and where mistakes have been made, in order to develop a system where health service management can assess “what went wrong, not who went wrong”.

Reporting systems in aviation enable this approach, whereas reporting mistakes/concerns in healthcare sees staff branded as ‘whistleblowers’ and shunned/isolated, he said.

“In aviation we assume we are going to get it wrong, and all our systems are designed around that. We expect error, we don’t blame the individual for that. We have reporting systems where we can speak up without the fear of disciplinary action or dismissal. It’s called a just culture.”

There is a multilayer approach of safety net after safety net in aviation, eg, checklists, Captain Downey added.

“Checklists have not worked well in many healthcare settings because the focus is on the bureaucratic angle of getting them signed and in the notes for the lawyers. Whereas in aviation we keep no record of them and see them as our last line of defence before having an accident,” he commented.

There is also a culture of learning and secondary prevention in aviation, Captain Downey said.

“We use reports to tailor our training in a very short timeframe – often weeks. Research shows the equivalent in healthcare as taking up to 17 years.”

Summarising his key points, Captain Downey stressed that errors can and do occur, but identifying where things can go wrong and a “plan B” can reduce errors.

Captain Downey provides error management training for the healthcare sector, with further information on his website www.Frameworkhealth.net. He has also written a book, Oops! Why Things Go Wrong, which is available from all usual outlets.