Another Look at Aviation as a Healthcare Model

By William A. Hyman

It has been popular to compare aviation’s safety record and procedures to similar processes in healthcare, usually with the notion that healthcare lags aviation in adopting a firm safety-oriented methodology (Carr, 2006; Pronovost et al., 2009; AHA, 2011). There can be considerable challenges when making such cross-discipline comparisons including staffing, training, mission scope, and perhaps personal risk. If these challenges are not adequately met, the lessons supposedly learned may not actually be transferable from one profession to another. Or worse, thinking that they are readily transferable may lead to a false sense of accomplishment when one or more safety “fixes” are implemented.

One aspect of the aviation-versus-healthcare comparison that has not received sufficient attention is a direct comparison of the task structures and responsibilities of pilots versus nurses. As shown in the table below, there are very substantial differences between the work and work environment of each. Further, these differences appear to be put nursing at a considerable disadvantage with respect to being able to consistently accomplish their work without identified adverse incidents. Thus the relative deficit in healthcare safety compared to aviation is likely a result of major staffing, system and work design issues that is not likely to be adequately addressed without significant effort and change. However this is not an excuse not to do it, rather it is a call for an level of effort that is commensurate with the risk.

Aviation	Nursing
Work is primarily stationery – at the controls	Work is mobile
Primarily a single task – although that task has multiple components	Multiple often relatively unrelated tasks
Dedicated assistant – the co-pilot	Informal assistance when called upon
Standardizes staffing levels – no exceptions	Variable staffing levels, including working even below local standards
Equipment in use configured and certified by a central integrator Associated substantial system feedback to operator	Independent equipment from multiple vendors Limited and non-integrated feedback
Tasks highly standardized	Variable tasks depending on patients and other duties
Highly trained and certified on specific equipment Mandatory refresher and emergency training	Variable training – often on multiple versions of the same devices Limited refresher and adverse event training
Mandatory near miss (close call) reporting Extensive	Haphazard reporting
Activity is partly under direct and continuous observation by third party (FAA)	No supervisor/third party observation
Pilot shares physical risk with passengers	Physical risk not shared
Clear outcome expectations – including by public	Possibly variable expected outcomes depending on patients, making it hard to identify untoward outcomes
Extensive external accident investigations	Primarily internal accident investigations – if at all

William Hyman is professor emeritus of biomedical engineering at Texas A&M University. He now lives in New York where he is adjunct professor of biomedical engineering at The Cooper Union. Hyman may be contacted at w-hyman@tamu.edu.

References

AHA Resource Center. (2011, April 11). Aviation and patient safety, American Hospital Association. Available at http://aharesourcecenter.wordpress.com/2011/04/11/aviation-and-patient-safety/

Carr, S. (2006). The joy of cross-fertilization. Patient Safety & Quality Healthcare, 3(2). Available at www.psqh.com/marapr06/editorial.html

Pronovost, P. J., Goeschel, C. A., Olsen, K. L., et al. (2009). Reducing health care hazards: Lessons from the commercial aviation safety team. Health Affairs, 28, 479-489.