It’s safer 35,000 feet in the air than it is in hospitals so what can doctors learn about safety systems from the airline industry?
Airline captain Richard Champion de Crespigny charges across the stage, reeling off figures at an alarming speed.
The number of explosions heard four minutes after QF32 took off from Singapore’s Changi airport (two); the number of the plane’s systems affected after the explosion in engine two (21 of 22); number of holes in a wing (several) the number of checklists spewing out from the plane’s emergency system (over 400) the number of people on board the flight (469).
The uncontained engine failure successfully navigated on November 4, 2010 by the Sydney pilot with the French surname “Champion de Crespigny” was an unprecedented event.
The probability of the engine failing was 10 to the power of minus 14.7.
The Qantas pilot and AM was invited to deliver this year’s presidential lecture at COSA’s annual scientific meeting in Sydney, to share insights on some of the keys to the successful management of high-risk scenarios.
It’s the first time the address has been given by someone outside of medicine, explains COSA president Professor Phyllis Butow, adding that oncology and aviation share much in common.
“In the airline industry and in cancer you hold people’s lives in your hands, so that immense responsibility of making sure you land a plane full of people and the immense responsibility that oncologists and the oncology teams have to land people in good health there’s a sort of shared honour and burden in that.”
HOSPITALS ARE MORE DANGEROUS THAN AEROPLANES
The probability of dying during an activity is measured using micromorts: one unit equals a one-in-a-million chance of death.
Walking into a hospital is worth 49 micromorts, as calculated by the statistics on medical accidents and errors, de Crespigny tells the audience of COSA delegates.
In comparison, one micromort is equivalent to flying 19,600 km or ten average flights in commercial jet aircraft.
“In other words, one hospital visit is equivalent to 490 average (two hour) flights. That’s just facts.”
This isn’t the first time comparisons have been drawn between aviation and healthcare.
According to a paper published in 2016 by UK researchers while the number of worldwide flight hours doubled to 54 million in the two decades to 2013, the number of fatalities has fallen from approximately 450 to 250 per year, the authors write.
“In a safety-centric organisation, shaming and bullying have no place,” – de Crespigny
“This stands in comparison to healthcare, where in the USA alone there are an estimated 200,000 preventable medical deaths every year, which amounts to the equivalent of almost three fatal airline crashes per day,” they noted.
“As the renowned airline pilot Chesley Sullenberger noted, if such a level of fatalities was to happen in aviation, airlines would stop flying, airports would close, there would be congressional hearings and there would be a presidential commission. No one would be allowed to fly until the problem had been solved.”
A CULTURE OF SELF-REPORTING
Healthcare could stand to benefit from taking a leaf out of the aviation rule book, but this would require cultural change.
In a safety-centric organisation, blame and bullying have no place, says de Crespigny, and honest mistakes are never disciplined.
“If you don’t have that culture of people self-reporting to identify the errors and then letting authorities change the safety procedures to prevent the error happening again, errors tend to be repeated, errors tend to be hidden and safety plateaus.”
Promoting safety also means proving fitness for the job, he says.
“How many times after surgeons leave the College of Surgeons are they re-certified?”
“For pilots it’s seven times a year, four times in a simulator. We’re taken to hell and back, we’re sweating we are pushed into things that are hard and uncomfortable. Sometimes we pass, sometimes we fail.”
“We are continually re-certified, there is a medical check once a year, emergency procedures (check), there’s a route check (where a senior pilot assesses a real-life flight)”.
RECORDING DATA INCREASES TRANSPARENCY
High levels of transparency are also crucial and doctors should not be afraid of increased surveillance, such as having surgeries recorded, de Crespigny says.
“In medicine when surgeries are recorded safety goes up,” he says.