Excuses, excuses, excuses. I don't fucking care how difficult it is to make healthcare better. Do it anyway! Stroke care is a complete failure, try fixing that first.
http://www.medpagetoday.com/Blogs/KevinMD/57235?xid=nl_mpt_DHE_2016-04-09&eun=g424561d0r
There's been a lot of talk for quite some time in healthcare quality
improvement circles about why healthcare can't be as safe as airline
travel. Some of the reasons behind asking this question are very valid,
as there are many things healthcare can learn from the aviation
industry. Others, however, are complete fallacy; because on so many
levels, it's like comparing apples to oranges.
Over recent weeks, I've heard the debate resurface again, with the
same quality improvement thought leaders using the same old arguments,
without being grounded in the reality of frontline medicine.
Slowly
but surely, patient safety is taking its rightful place at the
forefront of American medicine. Ever since the landmark report from the
Institute of Medicine in 1999, "To Err is Human: Building a Safer Health
System," the issue has been gaining increased traction year on year.
Dismal patient safety statistics in some hospitals are correctly being
highlighted by the media, with pressure growing on senior leadership and
administrators to vigorously address any shortcomings. And not just in
this country. Recently, the United Kingdom's National Health Service
published a long-awaited review on patient safety, which is hoped will
lead to a major cultural shift and philosophy of zero harm for patients.
Hopefully great changes are around the corner. After all, if we cannot feel safe in hospitals, where can we feel safe?
Many of the leading voices of the patient safety movement are quick
to draw a comparison with aviation, which has successfully used
protocols to make flying a much safer experience over the last few
decades. So much so that the airline industry is now considered second
to none in terms of safety. I don't doubt the earnestness of such
juxtapositions -- from healthcare leaders who are committed to the
cause. But as enviable as the aviation industry's achievements may be, I
feel that some of our colleagues may be a bit overzealous in drawing
frequent parallels. There are in fact many reasons why a straight
comparison between aviation and healthcare is extremely limited.
Firstly, and quite obviously on a human level, patients are real
living people, whereas an airplane is simply a machine. The importance
of human contact, empathy, compassion, a willingness to learn and listen
to concerns, and the ability to spend adequate time with patients, will
always be the first pillar of promoting a culture of safety and
thoroughness in clinical settings. Checklists to improve systems are
wonderful in mechanical areas like operative care and inserting central
lines, but can only go so far without the most important virtues of
being a doctor or nurse.
Second, apart from the first few haphazard days of early flight after
the Wright brothers changed the course of human history, flying has
always been relatively safe compared to healthcare. Some current reports
suggest that as many as 1 in 5 patients are harmed in hospitals. That's
a truly staggering and frightening number, and represents a higher
baseline from which we need to improve. (For some perspective, even
during the darkest days of World War II, Allied airplane losses barely
approached such high percentages.)
Aircraft
are engineered to be in the best possible shape before they fly.
Patients, on the other hand, are in the worst shape when they enter the
doors of the hospital. Medicine is by nature, a much riskier practice
than flying. The threshold for inflicting harm is therefore much lower,
however unacceptably high today's statistics may be.
Third, and perhaps most importantly, airlines -- or, at least, the
vast majority of them -- strive for excellent service and will always
have staff to serve you promptly during a flight. The pilot will be
totally dedicated to flying the plane, and will not fly without the
co-pilot and crew. I remember a flight I took from Philadelphia, which
was delayed because the airline needed to find an extra couple of cabin
crew members. The passengers all waited patiently for well over an hour
by the gate, and a loud cheer erupted when we finally saw the airline
crew arrive. The plane simply would not take off without a complete set
of staff.
On the other hand, many frontline healthcare workers will testify to
the fact that patient safety incidents and errors tend to occur when
they are struggling with staffing levels and feel grossly overworked.
Compare the rest time given to airline staff in between long flights, to
the all too common scenario of having over fatigued frontline
healthcare staff in clinical settings.
A pilot is also only ever going to fly one plane at a time. Not that
it's realistic for a doctor or nurse to be allocated to just one
patient, but the workflow is very different, with healthcare tasks
frequently interrupted with new clinical issues and emergency
situations. Consequently, insufficient staffing can have an acute effect
on outcomes and the ability to perform safely. Any healthcare
administrator who seriously wants to improve patient safety without
first and foremost making sure that their staffing levels in that
particular department are adequate, may be doomed to fail (in
healthcare's defense, it is much easier to plan for the staffing levels
needed for a booked flight than the typical unpredictable day in
hospital).
So does all this mean that the aviation industry comparison is
completely invalid? Absolutely not. Their safety record is one that we
can only hope to emulate over time. But the two industries are vastly
heterogeneous, and to say that safety in medicine should follow in the
path of flying airplanes, grossly oversimplifies a complex problem. It's
highly doubtful that aviation holds all, or even most, of the answers
as we strive to make hospitals safer.
Suneel Dhand is an internal medicine physician and author of three books, includingThomas Jefferson: Lessons from a Secret Buddha. He is the founder and director, HealthITImprove, and blogs at his self-titled site, Suneel Dhand. This post appeared in KevinMD.com.
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