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Analysis Quality Improvement

Can we import improvements from industry to healthcare?

BMJ 2019; 364 doi: (Published 21 March 2019) Cite this as: BMJ 2019;364:l1039
  1. Carl Macrae, professor of organisational behaviour and psychology1,
  2. Kevin Stewart, medical director2
  1. 1University of Nottingham, Nottingham University Business School, Centre for Health Innovation, Leadership and Learning, Nottingham, UK
  2. 2Healthcare Safety Investigation Branch, Farnborough, UK
  1. Correspondence to: C Macrae carlmacrae{at}

Healthcare has more to learn from other industries, including aviation—but it’s more complex than we think argue Carl Macrae and Kevin Stewart

Exhortations to learn from other industries have been common in the world of healthcare improvement since the inception of the discipline.1 These are not always helpful. Recounting oversimplified improvement examples from other industries (often aviation) can provoke considerable frustration and scepticism among clinicians exposed to the unique challenges and everyday complexities of trying to improve healthcare. Patients are not aeroplanes, and hospitals are not production lines. Nonetheless, many successful efforts to improve the quality and safety of healthcare have taken inspiration from other industries. Here we re-examine some familiar exemplars from the aviation industry to show what is (still) to be learnt, even in areas that have made substantial improvements.

No simple solution

From simulation training2 to patient handover3 to structured communication4 to quality improvement itself,5 many healthcare improvement interventions have been adapted from industrial settings as diverse as civil aviation, nuclear power, and car manufacturing. Initially, learning from other industries seems to offer a simple shortcut to anyone trying to improve healthcare. Other industries have spent decades developing tools, methods, strategies, and techniques to improve quality and safety: why not just apply these in healthcare?

Of course, it is not that simple. Translating and adapting improvement techniques to healthcare is hard and has had varied results. Some interventions, such as those aimed at reducing infections related to central venous catheters, have proved popular and successful6; others, such as incident reporting systems, have met with frustration and failure.7 Initial enthusiasm for oversimplified, large scale attempts to apply a new improvement technique often quickly gives way to confusion, complication, and criticism.89

Despite these difficulties and frustrations, looking to other industries for ideas …

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