Almost a decade has passed since Captain Chesley ‘Sully’ Sullenberger’s revered landing of US Airways Flight 1549 on the Hudson River. A bird strike rendered both engines unusable, yet the ‘miracle on the Hudson’ was such that all 155 passengers and crew survived. The pilots and crew were awarded the Master’s Medal of the Guild of Air Pilots and Air Navigators, and later immortalised in a film starring Tom Hanks and directed by Clint Eastwood.  

But this is not Captain Sullenberger’s only contribution to aviation safety.  He has written extensively on the topic, and also on its relevance to safety in healthcare.¹ “What we have right now, quite frankly, in healthcare,” he tells us, “are islands – visible islands of excellence in a sea of invisible failures, with risk lurking just below the waterline”. In the US alone, around 200,000 people die annually from preventable medical errors.² The equivalent statistic for Ireland would be about 3,000 – or, if you like, a jumbo-jet crash every two months. In reality, your chances of dying in an aviation disaster are less than one in 10 million. Imagine that this was not the case and aviation statistics were comparable to those of healthcare. Would you ever fly again?

Aviation is an industry that constantly learns from its mistakes, as outlined by Kapur et al (2015).³ The domains cited are threefold: latent factors ranging from national to team culture; active factors that include the use of checklists, training, crew resource management and the concept of the ‘sterile cockpit’ (essentially an environment free of unnecessary distractions); and performance analysis such as comprehensive detection, reporting and investigation of incidents, including near misses. 

Healthcare and the airline industry have a lot in common in that they are both complex, risky undertakings dominated by a single profession. But there are many key differences, as outlined by Kapur et al. While medicine has existed for millennia, aviation is barely a century old. Individual pilots usually operate one or two types of aircraft at most, but a doctor must know how to manage a wide range of equipment, symptoms and diseases. Passengers are usually healthy and seldom interact with their pilots but patients are sick and vulnerable and expect direct input from their doctor. The aviation industry is automated and computerised with far more checklists and safeguards than in healthcare.  Unlike healthcare, aviation has strictly-enforceable rules to prevent the adverse effects of fatigue and alcohol. Fatalities in aviation occur in their hundreds and tend to include the crew, while fatalities in healthcare occur singly and do not involve staff. Finally, adverse aviation events are always investigated at a national level with significant media scrutiny, unlike most adverse events in healthcare.

In addition, we cannot ignore the concern that, where adverse healthcare incidents are investigated publicly, there is often significant personal blame attached to the clinician regardless of multifactorial shortcomings in the environment in which they work. Injustices such as Bawa-Garba and Corbally seem unheard of in aviation. At every level, it behoves our health service and regulators to prioritise safety and ensure blame-free error reporting is the norm. Just like in aviation.

References

1. Sullenberger C and Chesley B. ‘Sully’ Sullenberger: making safety a core business function. Healthcare Financial Management (2013); 67:50-4
2. James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Safety (2013); 9:122-8
3. Kapur N, Parand A, Soukup T, Reader T, Sevdalis N. Aviation and healthcare: a comparative review with implications of patient safety. J Royal Soc Med Open (2015); doi:10.1177/2054270415616548