Aviation safety initiatives could help improve New Zealand hospital safety culture

12 May 2011

Aviation safety initiatives such as using first names between colleagues, recording all hospital telephone conversations and removing individual responsibility for safety training could help to reduce medical errors and improve hospital safety culture in New Zealand, an Auckland health economist believes.

Dr Rhema Vaithianathan, an Associate Professor with The University of Auckland Business School’s Department of Economics, says adopting more of the safety initiatives used in commercial aviation could see medical errors drop and improve Kiwi health team safety across the board.

As part of an international group of researchers from the United Kingdom and the United States, Dr Vaithianathan has recently reviewed 15 aviation safety initiatives to see if they could be adapted for healthcare.

The multi-disciplinary group included doctors, pilots, economists and an ex NASA astronaut, and gauged which safety initiatives were most likely to transfer successfully to healthcare.

The initiatives fell into three themes – downplaying the role of "heroic" individuals in favour of teams and organisations; increasing and applying group knowledge of safety and values; and promoting safety through better design of the working environment, Dr Vaithianathan says.

“These recommendations will be controversial, particularly those designed to discourage clinicians from improvising alone in the face of system failures,” she says.

“However, similar safety initiatives have been shown to change the culture of healthcare staff over several years, and have successfully reduced mortality rates. This success could be enjoyed in New Zealand.”

Other measures that could be borrowed from aviation relate to how the work environment is designed and how clinical procedures are managed. Dr Vaithianathan says in some British hospitals, nurses are required to wear brightly coloured bibs when administering medication as a means of signalling that they should not be interrupted.

“This is akin to the ‘sterile cockpit’ rule used in modern airlines, which requires pilots and cabin crew to refrain from chatting and other non-essential activities during the critical phases of a flight,” she says.

Aviation is safer than healthcare, with one passenger dying per 10 million flights compared with one in every 300 British hospital patients dying because of medical error.

However, Dr Vaithianathan says where ideas have been translated successfully from aviation, they appear to be dramatically successful. For example, the WHO surgical safety checklist is an idea that was transferred from aviation to operating theatres.

“This simple checklist has been shown to reduce mortality by 33% at a cost of just 11 dollars per patient. I can’t think of many other treatments that are anywhere near as cost-effective,” she says.

“I would be the first to recognise that not all our 15 examples will be suitable or appropriate for health care. Safety comes at a price, and the challenge for clinicians and managers will be to find that ‘sweet spot’ where the costs are relatively small and the gains are worthwhile.”