Intended for healthcare professionals

Education And Debate

On error management: lessons from aviation

BMJ 2000; 320 doi: (Published 18 March 2000) Cite this as: BMJ 2000;320:781
  1. Robert L Helmreich (, professor of psychology
  1. Department of Psychology, University of Texas at Austin, Austin, TX 78712, USA

    Pilots and doctors operate in complex environments where teams interact with technology. In both domains, risk varies from low to high with threats coming from a variety of sources in the environment. Safety is paramount for both professions, but cost issues can influence the commitment of resources for safety efforts. Aircraft accidents are infrequent, highly visible, and often involve massive loss of life, resulting in exhaustive investigation into causal factors, public reports, and remedial action. Research by the National Aeronautics and Space Administration into aviation accidents has found that 70% involve human error.1

    In contrast, medical adverse events happen to individual patients and seldom receive national publicity. More importantly, there is no standardised method of investigation, documentation, and dissemination. The US Institute of Medicine estimates that each year between 44 000 and 98 000 people die as a result of medical errors. When error is suspected, litigation and new regulations are threats in both medicine and aviation.

    Summary points

    In aviation, accidents are usually highly visible, and as a result aviation has developed standardised methods of investigating, documenting, and disseminating errors and their lessons

    Although operating theatres are not cockpits, medicine could learn from aviation

    Observation of flights in operation has identified failures of compliance, communication, procedures, proficiency, and decision making in contributing to errors

    Surveys in operating theatres have confirmed that pilots and doctors have common interpersonal problem areas and similarities in professional culture

    Accepting the inevitability of error and the importance of reliable data on error and its management will allow systematic efforts to reduce the frequency and severity of adverse events

    Error results from physiological and psychological limitations of humans.2 Causes of error include fatigue, workload, and fear as well as cognitive overload, poor interpersonal communications, imperfect information processing, and flawed decision making.3 In both aviation …

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