Is there a doctor on this flight?

Scientell is working with the Australian Council of Learned Academies (ACOLA) to synthesise a wealth of information into a book on securing Australia’s future. As part of this, we have examined the contribution that learning from error and failure can make to innovation and progress. This example demonstrates the way in which the medical profession is learning from the aviation industry’s approach to safety.

Safety is paramount for the aviation industry. Aircraft accidents are infrequent, but when they occur they involve massive losses of life. The exhaustive investigations that follow crashes have produced extensive literature into their causes, and new policies and regulations to improve safety. Research by the National Aeronautics and Space Administration (NASA) into aviation accidents has found that 70 per cent involve human error.

Writing in the British Medical Journal, Robert L Helmreich, professor of psychology at the University of Texas, states, ‘Error results from physiological and psychological limitations of humans. Causes of error include fatigue, workload, and fear as well as cognitive overload, poor interpersonal communications, imperfect information processing, and flawed decision making.’

‘In both aviation and medicine, teamwork is required, and team error can be defined as action or inaction leading to deviation from team or organisational intentions. Aviation increasingly uses error management strategies to improve safety. Error management is based on understanding the nature and extent of error, changing the conditions that induce error, determining behaviours that prevent or mitigate error, and training personnel in their use.’

Diagnosis should include data from confidential incident reporting systems and surveys, systematic observations of team performance, and details of adverse events and near misses.

It is now commonplace for medical doctors to learn from the approach to error and failure that has been refined and systematically adopted in aviation.

The error management approach that Helmreich advocates includes:

• Dealing with latent factors that have been detected, changing the organisational and professional cultures, providing clear performance standards, and adopting a non-punitive approach to error (but not to violations of safety procedures);
• Providing formal training in teamwork, the nature of error, and in limitations of human performance;
• Providing feedback and reinforcement on both interpersonal and technical performance; and
• Making error management an ongoing organisational commitment through recurrent training and data collection.

As physician Dr Lucian Leape, a physician and professor at Harvard School of Public Health, states:

‘The most fundamental change that will be needed if hospitals are to make meaningful progress in error reduction is a cultural one. Physicians and nurses need to accept the notion that error is an inevitable condition, even among the conscientious professionals with high standards. Errors must be accepted as evidence of system flaws not character flaws.’ ^[1]

^[1] Lucian L Leape, Error in medicine. JAMA, 272:23, 1851-1857, (1994)