Patient Safety vs. Passenger Safety: What Can Healthcare Learn from the Airline Industry?

According to the American Medical Association, 98,000 patients per year die due to “preventable medical error.” More recent studies suggest that somewhere between 250,000 and 400,000 patients per year die in America due to malpractice. If it were ranked as a cause of death by the CDC, malpractice would be either the third or fourth leading cause of death in America.

Believe it or not, nearly 25% of all patients in hospitals suffer from an act of malpractice with varying degrees of consequences. Many suffer no harm at all, kind of the “no-harm-no-foul” rule. However, roughly 1% or 2% of all patients suffer very serious or deadly harm due to medical errors. That may sound like a small percentage until you think of how many patients a day there are in American hospitals.

Better yet, what if the 1% medical error rate were acceptable for airline travel? Each day, over 1.7 million people board a commercial airplane in America. If we applied the same error rate, at least 17,000 people per day would suffer serious injury or death. However, the airline industry has gotten so good at passenger safety that a person could fly every day for 38,000 years before ever being involved in a fatal crash.

Most of us fly and we all go to the doctor or hospital. So why is it that these two industries we all depend on have such dramatically different safety records? A closer look into the science of complex systems in healthcare could be the solution to this problem.

According to Dr. Bruce Ramshaw, a general surgeon, one reason that patient safety has been hard achieve is that the healthcare industry tries to implement “one size fits all” approaches. However, healthcare is too complicated for that. Dr. Ramshaw uses the aviation industry as an example of how to look at safety. The airlines have managed to keep people safe through exhaustive research into all of the many processes and procedures that are required to make airplane travel a reality. They then break down each of these processes and ask, “how can we do this better?” He suggests that the healthcare industry must do the same.

Each medical facility needs to be engaged in specific safety plans and protocols. Safety checklists need to be crafted for the types of patients seen and types of procedures performed and each unit must communicate effectively and efficiently with the next unit. For example, the pathology lab at the hospital must always be able to communicate findings with the physician’s office and know that the results were received, reviewed, and communicated to the patient.

Also, doctors must be involved in safety policy and protocol creation. They cannot just dump this off as something for their office manager to deal with. Likewise, instead of intimidating their staff, doctors must be more accountable to them. For example, a surgical nurse needs to be able to remind a surgeon to use safety devices, such as a C02 detector during intubation, instead of being intimidated by her superior.

These are just a few simple examples of what needs to be a far more involved and in depth review of patient care in American hospitals and healthcare offices. By applying the science of complex systems, it can be done. If 1.7 million Americans can fly every day with a nearly perfect safety record, then we should all be able to trust that when we go to the hospital we won’t die or be seriously harmed by a preventable mistake.


From the Patient Safety America, Houston, Texas. James, PhD, Patient Safety America, 14503 Windy Ridge Lane, Suite 200, Houston, TX 77062

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