Why Can’t Hospitals Learn To 'Fly'?

— Hospitals need to learn from the aviation industry, says David Nash, MD, MBA

by David Nash, MD, MBA, FACP, Contributing Writer, �鶹��ý March 23, 2016

David Nash is the Founding Dean Emeritus and Dr. Raymond C. and Doris N. Grandon Professor of Health Policy at the Jefferson College of Population Health. He is a board-certified internist. Follow

In an unusually emphatic response to a series of safety incidents that occurred a little more than a year ago, the nation's third-largest airline recently called for all 12,000 of its pilots to focused on safety issues and teamwork.

This should come as no surprise.

After a particularly disastrous crash in 1977, the aviation industry made an in-depth, brutally honest assessment of its procedures – including the traditional hierarchical structure for flight crews – and deliberately converted to a "culture of safety."

The aviation industry has served as a model for the healthcare industry since the 1980's; nevertheless, the number of patients harmed and the volume of potentially avoidable adverse outcomes is still unacceptably high.

In fact, medical errors remain the third leading cause of death in the U.S. (up to 440,000 Americans ) and wrong-site surgeries continue to occur up to 50 times each week nationwide.

In his book, "," former pilot John Nance made a convincing case that, despite our ongoing efforts to improve processes and report outcomes, we continue to fail because we have not made the changes necessary to support a culture of safety.

Case in point: Early this month, an investigative reporter from a Davenport, Iowa, television station revealed that at Genesis Health System.

Although no patient deaths or serious medical consequences ensued for these patients, a state inspector noted that the surgeons were not fully participating in "time-outs" -- a critical safety procedure in which an operating team is supposed to double-check and document the identity of the patient, the procedure, and the site before making an incision.

What came next illustrates Nance's assertion -- although the health system disciplined the surgeons involved, it failed to immediately implement a plan to ensure that time-outs occur and to mandate re-education for all surgeons and other members of surgical teams accordingly so that future patients are not at risk.

We haven't learned yet, but it is my sincere hope that eventually hospitals will learn to "fly" just like their counterparts in the aviation industry.