Ive just finished reading a fascinating new book, Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care. Its by John Nance, a lawyer, commercial pilot and aviation-safety analyst for ABC World News. Why is someone with that background writing about hospitals? Two reasons, actually. Nance has advised the medical community on patient-safety and medical-practice improvement for two decades. And healthcare quality experts increasingly are turning to aviation for a template for how to reduce systemic errors that kill people.
What aviation can tell us about patient safety
Nance, a founding member of the National Patient Safety Foundation, has written a profound assessment of American hospitals and the people who work in them. He thinks a hospital is one of the most unsafe places in the world. He poses this question: How can it be that in 2008, a checked bag on an airline flight is still exponentially safer than a patient in an American hospital? Simply put, one industry has learned the realities of what it takes to make a human system safe, and the other has not.
That is a provocative statement in light of the well-publicized efforts by so many hospitals and healthcare systems to make their institutions safer for patients. And yet, in spite of all the work being done, the evidence is pretty convincing that not enough has changed. In an introduction to Why Hospitals Should Fly, Lucian Leape of the Harvard School of Public Health writes: The facts are irrefutable. Despite the wake-up call from the Institute of Medicine in 1999, tens of thousands of patients still die unnecessarily and hundreds of thousands are injured by medical mistakes every year.
Nance uses a fictional 240-bed not-for-profit hospital in a suburb of Denver as the prototype of the kind of hospital he envisions, one that expends every effort in pursuit of taking care of patients. In such a facility, every staff member knows that no matter how routine something may appear, theres still a good chance something could go horribly wrongmuch like Murphys Law. That means everyone has to drop their egos, stop the turf wars and begin to respect and work with one another.
This philosophy is best summed up as recognizing the fallibility of human beings. Human beings always make mistakes regardless of their training, experience or determination, Nance writes. In other words the universal constant is that human infallibility is impossible, and those who build a system that depends on an absence of serious human mistakes will fail utterly.
Therefore in order to make sure mistakes are kept to a minimum, a set of six guidelines is set forth in order to implement Nances system of safety. They include No. 1: Since human infallibility is impossible, the only chance to keep human errors from hurting patients is by creating collegial interactive teams. No 2.: Collegial interactive teams cannot be effective without mutual caring and support. And No 6: There can be no barrierless communications if the team leaders control is based on hierarchical snobbery, defensiveness or condescension.
A system that recognizes human failing and works on the premise that mistakes will be made enables a hospital to employ ways to ensure patients are cared for and protected always, Nance believes. What he is really saying is that if you want to really improve your quality of care, you need to establish care teams and do as the airlines did decades ago, which is to make sure that through teamwork, continuous quality improvement and systems of checks and double checks, at least nobody gets harmed while you are providing your service. At best, they wind up being made whole again.
Charles S. Lauer is the former vice president- publishing and editorial director of Modern Healthcare. He now is a consultant to the healthcare industry and also serves on the boards of healthcare companies.
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