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We can learn much from the air force

BMJ 2011; 343 doi: (Published 08 December 2011) Cite this as: BMJ 2011;343:d6464
  1. Annelies E Mitchell, medical student, Cardiff University School of Medicine, Cardiff CF14 4XN, UK,
  2. Thomas A Eastwood, pilot, RAF Benson, Wallingford OX10 6AA,
  3. Ian M Mitchell, consultant cardiac surgeon, department of cardiac surgery, Nottingham City Hospital, Nottingham NG5 1PB

The NHS has begun to learn lessons from other professions and industries. An example derived from aviation is the introduction of safety checklists. A 2008 World Health Organization directive now requires surgical teams to complete a theatre checklist to ensure correct identification of the patient and the operation to be performed and that equipment is available ( However, checklists alone do not improve patient safety. Anecdotal evidence suggests that in many cases such imposed checklists are resented; are too non-specific; and are often completed in haste, with a routine “yes” being given when really the answer was “no.”

The Royal Air Force (RAF) is a large, financially stretched, public sector employer that has many similarities to the NHS, and we may have much to learn from it. Correct completion of safety checklists is a training priority for aircrews, and gaining competency in the completion of such checklists is a prerequisite before a new pilot starts flying. The checklists are highly …

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