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Military rather than civil aviation holds the answers for safer healthcare

BMJ 2013; 347 doi: (Published 19 September 2013) Cite this as: BMJ 2013;347:f5570
  1. Robyn Clay-Williams, postdoctoral research fellow in human factors, Centre for Clinical Governance Research, Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney 2052, Australia
  1. r.clay-williams{at}

Military aircrews understand the importance of managing risk because they have to keep working in worst case scenarios, just like doctors, writes Robyn Clay-Williams

Medicine has adopted several safety principles from civil aviation with mixed success. Examples include regulatory processes such as accreditation1 and incident reporting2 and standardisation techniques such as checklists3; the so called sterile cockpit, which forbids non-essential activity4; and handover briefings.5 Although treatment guidelines may benefit from standardisation, and regulation can improve the safety of medical devices and drugs, other areas, such as emergency departments and intensive care units, need to maintain flexibility to cope with developing situations. Translating rigid civil aviation processes indiscriminately into hospitals is not always appropriate.

A better industry to consider for healthcare functions that require flexibility and autonomy is not civil but military aviation. Civil aviation has zero tolerance for risk and …

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