Why healthcare should follow aviation’s culture of safety

System failures often manifest unreported or underreported safety issues and potential risks, illustrating a significant disconnect in the workplace. Healthcare leaders have recognized the correlation between the prevalence of silence and the occurrence of harm, underscoring the urgent need for cultural transformation. Drawing on the aviation industry’s proactive strategies, they’ve identified the necessity of fostering an environment where staff are supported and encouraged to voice concerns around system issues.

System-wide changes to healthcare in the 21st century have been modeled on well- established practices within the aviation industry. Even the idea of establishing a just culture originated in the 1980s in aviation. This occurred after it was recognized that the conditions for accidents were often known or suspected by people in the workplace who were afraid to speak up for fear of being reprimanded or humiliated. Healthcare workers have had the same fears.

To counter that hesitation, the aviation industry established processes that created an atmosphere of trust in which essential safety information could be shared openly so teams can learn from it. And where accountability—instead of punishment or humiliation—became the norm.

The success of aviation’s culture changes related to safety has been significant, with data showing that flying today is safer than ever. In healthcare, however, the number of preventable inpatient deaths in the U.S. has been estimated between 44,000 and 98,000 annually.

Learning from near-misses

“Near-misses”—events that could have caused serious injury or death—occur in both aviation and healthcare and can be an impetus to investigate safety issues and take corrective action to prevent serious or fatal consequences in the future. But that won’t happen without the reporting of the system failures that led to the near-misses, or the disclosure of the near-miss itself.

For example, a pharmacy might dispense the incorrect dosage of a prescription, but this error is realized and corrected by a nurse at the bedside before the medication is administered. Near-misses like these are a regular feature of complex systems like hospitals and, when reported and learned from, provide valuable opportunities to enhance safety.

Healthcare organizations have attempted to learn from near-miss events using event and incident-reporting processes modeled after the aviation industry. But applying successful aviation practices to healthcare, such as quickly addressing system-wide gaps, has not yet been fully achieved. A re-examination of the aviation industry’s approach to learning from near-misses may provide valuable insights for the healthcare industry.

Extensive safety improvements in the aviation industry have been attributed to the implementation of more efficient safety protocols. Healthcare, wisely, has started to borrow the  following practices from aviation:

• Checklists. The checklist approach has been championed in aviation as a method to improve safety and reduce risk. When it is time to prepare for a flight, pilots use a multistep checklist to confirm that the flight course, weather patterns, radio setup, special runway information and other factors have all been taken into account to ensure the safest flight possible. The checklist approach has the same potential to save lives in healthcare by ensuring that simple standards are applied for every patient, every time.
   
• Threat and error management. The aviation industry places heightened focus on addressing risks through crew-resource management  and through threat and error management, which assumes that pilots will make mistakes and encounter risky situations during flight operations. Rather than try to avoid threats and errors, the primary focus of risk management is teaching pilots to manage issues so they do not impair safety. 
  
  When the same concepts are applied to healthcare, leadership teams recognize that mistakes happen and they attempt to foster a culture that emphasizes managing and learning from events.
   
• Digital transformation. Advances in event management and incident-reporting technology allow aviation teams to report incidents and near-misses, such as equipment malfunctions, unexpected adverse weather conditions, or loss of situational awareness by the flight crew.

In healthcare, using a technology-based incident reporting and management solution with actionable analytics driving better safety discussions can help organizations take a smarter approach toward identifying, addressing, and, most importantly, preventing risk. Digital reporting and analytics tools make it easy to capture data through desktop, tablet, or mobile devices, which helps leadership teams quickly identify and address areas of concern.

By looking to the aviation industry as a guide, healthcare organizations have taken strides toward incorporating greater safety into their operations and getting closer to the goal of zero harm.

Heidi Raines is the Forbes Books author of Shared Voices: A Framework for Patient and Employee Safety in Healthcare. She is founder and CEO of Performance Health Partners (www.performancehealthus.com), a software company providing patient safety, employee health and quality improvement solutions to healthcare organizations.