In a recent post, I discussed how some health care organizations are learning lessons from car racing. In a book titled Why Hospitals Should Fly?, John Nance (a professional speaker, pilot, and ABC News and Good Morning America aviation correspondent) suggested that health care organizations must learn principles from the aviation industry as their foundation for patient safety improvement.

The aviation industry, whether commercial or military, has long been admired by health care organizations. Aviation has achieved a substantial improvement in its safety from the 1930s to the present. This journey is very similar to the journey that health care has been undertaking for a while. Robert Helmreich, a psychologist that studies teamwork in health care and aviation, suggests:

"Pilots and doctors operate in complex environments where teams interact with technology. In both domains, risk varies from low to high with threats coming from a variety of sources in the environment. Safety is paramount for both professions, but cost issues can influence the commitment of resources for safety efforts."

Among the pioneer organizations in adopting principles in aviation is the Veterans Health Administration (VA). One of the main principles that the VA implemented is teamwork training that is based on Crew Resource Management (CRM). CRM, a requirement for flight crews worldwide, emphasizes developing skills in briefing, inquiry, assertion, workload distribution, vigilance, and conflict resolution. Its effectiveness in changing attitudes and behaviors in aviation is well documented. Other ideas that have been borrowed from aviation is simulation-based team training, checklists before surgery, as well as a general focus on designing error-proof systems.

However, not everyone is excited about the idea. Many experts rightly argue that "patients are not airplanes." David Gaba, an anesthesiologist, notes:

"Infinitely diverse human beings are not instrumented by nature to provide critical information about their physiology. At best, clinicians obtain a smattering of data from non-invasive external sources. Airplanes, on the other hand, are (usually) in good shape when we fly them (and there isn't a mechanic working on the aircraft during a flight at risk of severing a hydraulic line or the like)."

Others suggest that health care is so unique and complex and that patients are unpredictable. They warn that

"it is often assumed that copying and adapting the success stories of nonmedical industries, such as civil aviation and nuclear power, will make medicine as safe as these industries. However, the solution is not that simple."

What this seem to suggest is that successful applications of aviation-based ideas to health care should first be based on a good understanding of the differences and similarities between the two industries. While there are only 10 to 12 major airlines, there are about 5,000 hospitals and a similar number of ambulatory surgery centers. As a result, health care is more fragmented than aviation. Moreover, regulation in aviation is enforced by one federal agency, while governmental control in health care is variable.