Vic Management Interns' blog

Blog posts by Management Interns of the ACHSM based in the State of Victoria.


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Aviation accidents and patient safety

Aviation accidents and patient safety

Author: Yang Su

1st Year Management Intern

Date: 26 Apr 2019

There have been a number of fatal commercial aviation accidents in recent years, with the most recent being Ethiopian Airlines Flight 302 in March this year. As with previous fatal aircraft accidents, there has been extensive media coverage, with large scale investigations underway. This accident in combination with another accident in late 2018 involving Lion Air Flight 610, has resulted in the grounding of almost all Boeing 737 MAX 8 aircrafts around the world.­­­­1

Source: LLBG Spotter, reduce noise and color balance by Habitator terrae

Aviation is by no doubt a high risk industry, but it is a relatively safe one. The National Safety Council in the US estimated in 2017 that the lifetime odds of death for being a passenger on a plane is 1 in 188,364.2 This shows that it is highly unlikely for someone to die due to a plane accident. On the other hand, healthcare, the high risk industry that is often not perceived as one by the public, has a much lower safety profile.

The landmark report by the Institute of Medicine in 2000 estimated 98,000 people per year die from medical errors in hospitals in the US.3 In the same report, the authors estimated that ‘The likelihood of dying per domestic jet flight is estimated to be one in eight million. Statistically, an average passenger would have to fly around the clock for more than 438 years before being involved in a fatal crash.’3 In 2015, the UK secretary of state for health and social care spoke of 750 avoidable deaths in NHS hospitals every month, which is equivalent to an aircraft crashing each week.4

Local statistics from Australia is no less alarming. ‘Targeting Zero’, a 2016 review of Victorian hospital safety and quality, which led to the formation of Safer Care Victoria and Victorian Clinical Council, quoted data that ‘One in 10 hospital admissions involved a complication of care…and one in 20 complications resulted in the patient’s death.’5 These statistics may not come as a surprise to those who have worked in healthcare for years, and comparisons between aviation and healthcare safety have been made for decades. However, progress in patient safety has been painstakingly slow.6

Source: Safety by Nick Youngson CC BY-SA 3.0 Alpha Stock Images

The reasons for commercial aviation having a significantly better safety profile than healthcare has been broadly put into two categories: systems and culture.7 Translating systems from aviation to healthcare is not straightforward given the obvious differences between the two industries, although to date there have already been instances where health services adopted checklists and crew resource management, both of which are systems from aviation.8,9 Culture, on the other hand, healthcare can learn much from aviation. Aviation has a strong focus on safety culture. A top-level definition of safety culture is: ‘the set of enduring values and attitudes regarding safety, shared by every member of every level of an organisation.’10 James Reason, the psychologist who pioneered the ‘Swiss cheese model’, described safety culture as having five separate elements:

Safety culture

Informed culture Those who manage and operate the system have current knowledge about the human, technical, organisational, and environmental factors that determine the safety of the system as a whole
Reporting culture People are willing to report errors and near-misses.
Learning culture People have the willingness and competence to draw the right conclusions from their safety information system and the will to implement major reforms when the need is indicated.
Flexible culture Organizational flexibility is typically characterised as shifting from the conventional hierarchical structure to a flatter professional structure.
Just culture An atmosphere of trust is present and people are encouraged or even rewarded for providing essential safety-related information, but there is also a clear line between acceptable and unacceptable behaviour.

The first step to improvement is to recognise the need to improve, healthcare as an industry needs a better safety culture. Everyone within an organisation, regardless of title and position, contributes to its safety culture. For those of us working within healthcare, how can each of us contribute to a better safety culture within our health services, to stop these ‘planes’ from falling out of the sky?

References

  1. Wagner M, Ries B, Westcott B. Boeing 737 Max 8 planes grounded after Ethiopian crash. CNN [Internet]. 2019 Mar 14 [cited 2019 Mar 21]. Available from: https://edition.cnn.com/world/live-news/boeing-737-max-8-ethiopia-airlines-crash/index.html
  2. National Safety Council. Odds of Dying [Internet]. Itasca, IL; National Safety Council; 2017 [cited 2019 Mar 21]. Available from: https://injuryfacts.nsc.org/all-injuries/preventable-death-overview/odds-of-dying/
  3. Institute of Medicine. 2000. To Err Is Human: Building a Safer Health System. Washington, DC: The National Academies Press. https://doi.org/10.17226/9728.
  4. Oliver D.David Oliver: Learning from deaths in hospital BMJ 2018; 361 :k969
  5. Duckett S, Cuddihy M, Newnham H. Targeting zero, the review of hospital safety and quality assurance in Victoria [Internet]. Melbourne: State of Victoria; 2016 [cited 2019 Mar 21]. 309p. Available from: https://www.dhhs.vic.gov.au/sites/default/files/documents/201610/Hospital%20Safety%20and%20Quality%20Assurance%20in%20Victoria.pdf
  6. Wilson R, Van Der Weyden M. The safety of Australian healthcare: 10 years after QAHCS. Med J Aust 2005; 182 (6). doi: 10.5694/j.1326-5377.2005.tb06694.x
  7. Hudson P.Applying the lessons of high risk industries to health care.BMJ Qual & Saf 2003; 12:i7-i12.
  8. Kapur N, Parand A, Soukup T, Reader T, Sevdalis N. Aviation and healthcare: a comparative review with implications for patient safety. JRSM Open. 2015;7(1):2054270415616548. doi:10.1177/2054270415616548
  9. Gordon H.Aviation: a pilot study for safety in gastroenterology?.Frontline Gastroenterology 2012;3:90-91.
  10. Piers M, Montijn C, Balk A. Safety culture framework for the ECAST SMS-WG. ESSI; 2009
  11. Ma M, Rankin W. Creating a more effective safety culture. AERO QTR 2014


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