Error Management: Lessons From Aviation

Error management: Lessons from aviation the author makes a direct comparison between those in the field of aviation and those in the medical field. He notes that both doctors and pilots operate in similarly complex environments. Both experience a variety of risk levels dependent on the environment. and, both are committed to safety. However, there are many differences between the two professions.

First, aviation accidents are typically of a much higher profile. They are more rare than medical accidents and often involve much more loss of life, and therefore are typically subjected to a much more exhaustive investigation regarding the causal factors. Medical accidents usually happen to individual patients and do not receive the level of publicity of aviation accidents. Despite this individualistic nature, "the U.S. Institute of Medicine estimates that each year between 44-000 and 98-000 people die as a result of medical errors" (Helmreich).

In both professions, human error is a major factor in accidents.

Physicians and pilots alike suffer from fatigue, excessive workload, lack of communication, imperfect information processing, and flawed decision making. Both fields also require teamwork to be successful, and ineffective teamwork, sometimes due to interpersonal conflicts amongst team members, can lead to disaster, in the case of aviation, or patient death, in the case of the medical profession. However, unlike the medical profession, aviation utilizes their mistakes as a learning tool to prevent future accidents. Error management strategies allow aviation to discover the nature of what conditions precipitated an accident, and how best to prevent this error from happening again. Helmreich describes lessons that can be learned from the aviation industry and be applied to the medical field.

Aviation has used multiple sources of data to get an accurate picture of aviation safety. One such source is surveying pilots and their crew members. These surveys allow for insight into the perceptions of the organization's commitment to safety, as well as facets of teamwork and leadership, and incidences of error.

As an example, the safety climate within an organization can be assessed by gauging what respondents feel is the appropriateness of junior crew members speaking up should a problem be observed. Surveys can also help define the professional culture, and the tendency to deny personal vulnerability, in pilots, as a whole. Surveys such as this have identified a surprising level of inaccurate self-perceptions amongst pilots who have indicated that they feel that they perform effectively while fatigued, do not report a change in decision making efficacy in emergency situations, and feel that their personal problems have no effect on their performance. This overconfidence can lead to error.

In combination with surveys, a non-punitive incident reporting system gives great insight into conditions that induce errors and the errors that are the result of these conditions. It is these types of innovative tools for error management that Helmreich believes can be converted usefully to the medical industry.

Personal Critique and Lessons Learned from the Article:

The article was well-written with many studies to back up the findings of the usefulness of the error management system discussed. It was interesting to see so many parallels between two diverse fields of occupation.

The stress levels, risks to human life, and the importance of teamwork were highlighted examples of similarities. However, it was the differences that were the most intriguing.

Clearly aviation accidents are more highly publicized than the individual medical accidents that occur each year; yet, it was startling to learn that it is estimated that up to nearly 100,000 people die each year from medical accidents, far less than aviation accidents. Although not as highly publicized, litigation following medical accidents, in the form of malpractice suits, would lead one to believe that the medical profession would be motivated to institute the types of processes and protocols that the aviation industry has developed. However, they have not and the need for this is illustrated effectively by the author.

The lessons learned from this article are two-fold. First, there are post-accident processes and procedures in place within the aviation field. Exhaustive investigations are conducted following an aviation accident, as well as release of public reports and remedial actions, in an effort to both be privately and publicly accountable for safety improvements. These processes are not simply lip service to the public, but worthwhile tools for the industry to make real changes to aviation as a means of improving safety and a way to prevent similar mistakes from happening in the future.