It has been almost two decades since "To err is human" was published, yet patient safety remains a concern in healthcare. To address this issue, healthcare organizations need to transition from being high-risk institutions to becoming highly reliable organizations (HROs). The aviation industry underwent this transformation in the late 1960s. What strategies can healthcare borrow from aviation to ensure hospitals are as safe as flights?
One strategy that healthcare can borrow from aviation is the use of checklists.
Using Checklists
Checklists are used extensively in aviation to ensure that every step is followed in the correct order. This can be applied to healthcare as well, where checklists can ensure that every step in a medical procedure is followed correctly and that no step is missed.
For example, Peter Pronovost proved the efficacy of a five-point checklist in Michigan ICUs. The implementation of this checklists reduced Catheter Associated Blood Stream Infection (CLABSI) rates to almost zero.
Pronovost's checklist focused on the basic steps that healthcare workers should follow when inserting catheters into patients. This included hand hygiene, use of sterile drapes and avoidance of femoral lines. The results were impressive, with a 66% reduction in CLBSI rates across Michigan hospitals. This success has since been replicated in other settings.
Simulation-Based Training
The next strategy is the use of simulation training. Aviation uses simulation training extensively to prepare pilots for emergency situations. Healthcare can use this strategy as well, where doctors and nurses can be trained to handle emergency situations in a simulated environment, preparing them to handle similar situations in real life.
Several studies have demonstrated the usefulness of simulation in training to enhance patient safety. For example, a study conducted by the University of Michigan found that medical residents who underwent simulation-based training were more proficient in performing medical procedures, such as intubation, compared to those who received traditional training. Another study from the University of California, San Francisco showed that simulation training led to a reduction in medical errors and an increase in patient safety.
Multidisciplinary Team Training
Crew Resource Training (CRT) is another strategy that healthcare can borrow from aviation. CRT trains aviation crew to work as a team, promoting effective communication and coordination. Healthcare can adopt this strategy by implementing team training, where healthcare providers work together as a team to provide patient care. This can help reduce medical errors and improve patient outcomes. Currently, healthcare training and education occur within individual silos, with the exception of life support training such as BLS, ACLS and ATLS. Unfortunately, this approach is not utilized for any other training.
This siloed approach to training and education in healthcare leads to a lack of collaboration and communication between healthcare professionals. It also results in a fragmented understanding of patient care. To improve patient outcomes and enhance the overall quality of care, it is essential to adopt a more integrated approach to healthcare education and training. By breaking down silos and encouraging interdisciplinary learning, healthcare professionals can gain a deeper understanding of how different areas of expertise intersect and influence patient care, thereby embracing a more holistic approach.
Learning from Mistakes
Aviation uses a system of reporting incidents and near-misses known as aviation safety reporting system (ASRS). This system promotes a culture of safety and encourages aviation personnel to report incidents without fear of punishment. Healthcare has adopted a similar system of reporting incidents and near-misses, but unfortunately, the number of incidents reported are few. This is due to a punitive culture where instead of taking a systems view, individuals are blamed for their actions.
Culture of Safety
It is crucial for healthcare organizations to shift their focus from blaming individuals to finding systemic solutions to prevent errors. Incident management can only be effective if it is combined with a culture of safety. This means creating an environment where staff members feel comfortable reporting errors, near-misses and unsafe conditions without the fear of punishment. Only then can a healthcare organization effectively learn from their mistakes and improve patient safety. It is important for healthcare leaders to prioritize safety and create a culture where reporting incidents is encouraged and valued. By doing so, healthcare organizations can ensure the best possible care for their patients.
Effective Communication
Finally, communication is key in aviation and can be applied to healthcare as well. Clear and effective communication between healthcare providers can help prevent errors and improve patient safety.
Communication errors remain the leading cause of errors and patient safety incidents. Healthcare professionals have taken on a valuable lesson from aviation – "read back" – to minimize errors. Read back is a process where the receiver of a message repeats the information back to the sender to ensure that the message was accurately received and understood. This helps to prevent miscommunications and errors that can lead to patient harm. By implementing read back in healthcare, medical professionals can improve the quality of care they provide and minimize mistakes. Additionally, fostering a culture of open communication and encouraging healthcare workers to speak up when they notice potential issues can further enhance patient safety.
By borrowing these strategies from aviation, healthcare can move towards becoming an HRO - A highly reliable organisation and improve patient safety. With the use of checklists, simulation training, crew resource training, enhanced communication and a culture of safety, hospitals can become as safe as flights.
