Head To Head

Have we gone too far in translating ideas from aviation to patient safety? No

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.c7310 (Published 14 January 2011) Cite this as: BMJ 2011;342:c7310
  1. David M Gaba, associate dean for immersive and simulation based learning and private pilot
  1. 1Stanford University School of Medicine, Simulation & EdTech, 291 Campus Drive, LK300, Stanford, CA  94305-5217
  1. gaba{at}stanford.edu

James Rogers (doi:10.1136/bmj.c7309) thinks that attempts to learn from aviation are ignoring fundamental factors in healthcare, but David Gaba argues that much more could be done

Analogies between medicine and aviation have been made on two levels: human factors and industry or institutional. Neither has gone too far. The human factors addressed include dynamic decision making in critical situations, team management and teamwork in acute care teams, management of fatigue, use of cognitive aids (such as presurgical checklists, equipment checkouts, and emergency procedures), optimising the physical and electronic work environment (data displays, user interfaces, alarms, etc), and safety culture.1 2 3 4

The analogies have worked particularly well for aspects of healthcare that mirror the cognitive profile of aviation pilots and controllers—those involving sick patients with rapid clinical change, interleaving of diagnosis and treatment, invasive procedures, and heavy use of technology. Thus in specialties such as anaesthesia, intensive care, emergency medicine, surgery, endovascular interventions, and neonatology the translation of ideas from aviation has been successful because it relates to fundamental human challenges of work that is cognitively similar between domains.1 2 3 4 There is extensive literature in healthcare peer reviewed journals on these topics, and typically the analogous practices in aviation long pre-date their …

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