David Oliver: Are comparisons between acute healthcare and the aviation industry invidious?BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2203 (Published 22 May 2018) Cite this as: BMJ 2018;361:k2203
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David Oliver is right; healthcare is very different from aviation. It is also very different from firefighting, oil exploration and deep-sea fishing, so attempts to implement safety practices from other industries without adaptation for the context and environment of healthcare are naive and will fail. What’s more, healthcare is not homogenous. Routine elective surgery, community mental health, emergency medicine, trauma surgery, chemotherapy administration and palliative care are all very different from each other and almost certainly need different approaches to safety as well. One safety model does not fit all of healthcare (1); practices that work well in one area won’t work at all in another.
Vincent and Amalberti (1) describe at least 3 very different safety models in high risk industries and they conclude that some of these might be adapted to some parts of healthcare. So, for example, in routine blood transfusion or chemotherapy administration we might be able to adapt some safety practices from high reliability organisations or civil aviation, but these practices would be completely unhelpful for emergency physicians and trauma surgeons working in high risk, rapidly changing situations who have more to learn from the model used by deep-sea fishing captains.
But, one of the things that aviation has done well (and healthcare has not) is safety incident investigation.
The aviation safety investigation model has many features which could benefit healthcare, if they could be suitably adapted, and this is what the Healthcare Safety Investigation Branch (HSIB) has been set up to do.
The aviation investigation body functions independently of the system in which it operates, meaning that it can make recommendations to system leaders, national bodies and regulators without fear of censure. Aviation investigators are trained, full time and independent of the organisations that they are investigating, not busy people expected to do investigations as well as their full-time jobs. Investigation methods are based on established safety science and human factors principles that seek systems level solutions to safety issues; they expect humans to fail, no matter how well-trained, hardworking or diligent they are, so focus on redesigning the systems in which humans work rather than blaming individuals. Investigators can also offer protection against legal or regulatory sanction for those whom they interview, something that is surely now needed in healthcare.
Draft legislation is currently being considered by the UK parliament to give HSIB a similar legal status to that enjoyed by the Air Accident Investigation Branch, including the ability to offer protection from legal and regulatory sanction to clinicians who make statements to safety investigators. This would represent a significant advance for patient safety, so while acknowledging the many differences between aviation and healthcare, we should also be humble enough to recognise where there is potential for us to learn and improve.
1). Vincent C. Amalberti R. Safer Healthcare; strategies for the real world. pp 27-37. 2016. Springer Open. London (available with open access at SpringerLink.com)
Competing interests: No competing interests