What pilots can teach hospital leaders about safety

Although the last airline fatality was in 2001, more than a decade ago, medical errors and healthcare-associated conditions result in 200,000 preventable deaths every year, according to Capt. Chesley "Sully" Sullenberger in an interview with the Stanford (Calif.) University School of Medicine this week.

"That's the equivalent of 20 large jet airliners crashing every week with no survivors," said Sullenberger, the pilot who safely landed US Airways Flight 1549 onto the Hudson River, saving 155 people on board.

Calling urgency to patient safety, the now retired pilot noted that healthcare is in a state of emergency, much like the one of his famous landing.
Like healthcare, aviation was once an industry based on individual crew preferences and a culture of blame, Sullenberger noted.

"The easiest thing for investigators, for officials to do, was to blame the dead pilots, and leave it at that," he said.

Today, though, there are formal processes in place to evaluate system problems and implement prevention strategies. The flight industry "transformed the culture of aviation from a blame-based system to a learning-based system" and one of predictability, reliability and regularization of processes, he said.

For instance, one strategy that crosses industries is introductions. Crew, oftentimes on major flights together, having never met other members of the team, introduce themselves--a technique echoed in some operating rooms before the start of a procedure.

Still, hundreds of surgeons don't use checklists, including for introductions, despite evidence that it cuts down on deaths, patient safety advocate and Harvard pediatric surgeon Lucian Leape told members of the American Medical Student Association at a patient safety symposium, the Philadelphia Inquirer reported.

Errors don't come only from individuals, but from systems, Leape noted.

John Nance, founder of the National Patient Safety Foundation, encouraged hospital leaders to put patient safety before profits.

"[H]ad Captain Sully Sullenberger and First Officer Jeff Skiles spent as little as 15 seconds discussing the financial advantages of trying to land an engineless jetliner on a runway versus setting it down in the waters of the Hudson River, we would have lost them," he wrote in a Hospital Impact post.

In an effort to survive profitability, C-suites and boards often panic and instead fail to prioritize patient safety, Nance said.

"Are we justified in temporarily shoving aside our previous focus on reaching zero harm to pump up the HCAHPS scores, spending time trying to make the dietary department a four-star restaurant while we pretty up the rooms and the greetings and ignore the wrong-site surgeries and MRSA infections that keep occurring?"

Nance encouraged hospitals to focus on their missions, even if that means redirecting dollars.

For more information:
- hear the Sully interview and read the summary by Stanford
- read the Philadelphia Inquirer article
- read John Nance's blog post on Hospital Impact