A Flight Tested Solution To Patient Safety Problems

News that hospital patients in Minnesota are no safer today than a decade ago comes as no surprise to those trying to reduce medical errors and injuries. The drive to make hospitalization less risky began in 1999, when a study by the prestigious Institute of Medicine estimated that more than 100,000 patients suffer from avoidable harm each year.

Since then, hundreds of millions of dollars has been spent on new patient safety initiatives of all kinds. Unfortunately, as The Star Tribune confirmed last month, hospitals are still the scene of too many botched procedures and preventable falls, infections, and misdiagnoses. What explains the persistence of failure that adds billions to our nation’s health care bill, costs many patients their lives, and leaves others with new medical problems?

Many well-intentioned safety efforts have fallen short because doctors, administrators, and other staff resist necessary changes in the hierarchical and often dysfunctional culture of hospital work. Patients get hurt or become even sicker when doctors, nurses, and other hospital staff fail to share information, don’t work effectively in teams, or ignore mechanisms – like hand-washing to prevent infection –designed to minimize human error. In too many hospital chains, fragmentation of care is an institutional shortcoming both endemic and unacceptable.

In our view, the quality of patient care in America won’t get better until the healthcare industry embraces the flight-tested model of teamwork training and workplace cooperation that has drastically reduced the dangers of commercial air travel.

In response to a series of horrific crashes four decades ago, the airlines didn’t just develop better safety checklists or new equipment to detect impending mechanical failures. The entire industry was compelled to adopt new safety protocols, known as Crew Resource Management. (CRM). As a result, flying today is safer than ever before—for airline crews and their passengers

CRM teaches those working in the cockpit, cabin, on the ground and in air traffic control how to communicate and cooperate. It requires everyone to solicit and listen to relevant safety information from other employees, regardless of their rank or job responsibility as well as to use standardized procedures that assure safety. Annual CRM training is now mandated for all flight personnel by the Federal Aviation Administration. Airline unions, like the Airline Pilots Association and the Association of Flight Attendants, have been heavily involved in the implementation and success of the program.

Whatever other job-related complaints they may have, any longtime pilot, flight attendant, or air traffic controller will vouch for difference that CRM has made in their industry. One of CRM’s leading advocates is Captain Chesley “Sully” Sullenberger, who arguably became the most famous pilot in America after his landing of a crippled US Airways jet in the Hudson River four years ago. Since retired, he is now helping hospitals incorporate CRM methods into their patient safety programs.

“Not long ago,” Sullenberger says, “there were captains in out cockpits who acted liked gods with a little ‘g’ and cowboys with a capital ‘C.’ You questioned the captain’s authority at your own peril, even if you were a fellow pilot.”

When CRM first emerged, some captains worried it would undermine their authority. According to Sullenberger, “others, like some doctors today, felt they didn’t need to learn the ‘soft skills’ of better communication and respectful interaction with co-workers.” Yet the consensus today is “that our cockpit management decisions are far better when we have regular input and information from all members of our aviation team, in the air and on the ground.”

Even where hospitals have realized the need for more “inter-professional training,” few have created a similar environment in which staff members feel free to challenge a physician or complain to an administrator. In medical schools and on the job, most doctors are not encouraged, much less required, to consult with skilled and experienced members of the same health care team who may have life-saving in-put.

Many tragedies could be averted and patient care improved if health care fully applied the lessons of aviation teamwork and safety. In our hospitals, it’s time to go beyond the checklist and actually reduce the terrible financial and human toll of avoidable medical errors.

Cross-posted at the Beyond the Checklist blog