jamesnixon.com

Process-ize Medical Service Delivery



If we delivered Air Safety the way the medical professions deliver service to their patients, there'd be a constant drizzle of molten aluminium from our skies. It's time to bite the bullet, pay the price, and arm the over-worked professionals with the tools and systems to save lives.

In June 2001 it was announced that in the Wimmera Base Hospital at Horsham in Victoria a program of using checklists, combined with a NO-FAULT incident / accident reporting system has led to a massive reduction in mistakes.

The comparably young airline industry adopted similar procedures for Pilots, Engineers and Controllers decades ago.

And why are we so paranoid about Asian airline crashes when, compared to everything else, even the Asian airlines (worst record) are miles in front of other areas of human endeavour?

Last decade more people died from hand gun deaths in the USA than from ALL worldwide aircraft accidents, shoot-downs etc since the end of WW2.

Meanwhile, between 50,000 & 100,000 people died by MIS-DIAGNOSIS / MEDICAL HANDLING in hospitals in the USA each year * … and those are the cases admitted.

In Australia it’s rumoured to be about 3,500 deaths.

What if the rest of the world applied the same standards to the medical profession as the airline business?

A minimum of Two Nurses and Two Doctors on every procedure, using Crew Resource Management skills and Standard Phraseology.

Plus they would have to undergo checks, like we do, every year:

Medical (1-3 days depending on age),

Simulator (4 days),

Emergency procedures (1 day),

Systems revalidation (half day),

Line check (2 sectors),

With many days of home-study and online exams required to be completed before each check.

Imagine the synergy of a group of Doctors working the problem, like we do with the airborne patient. Never again would Doctors be allowed to work by themselves again.

One day, flying into Brisbane from Melbourne, I had a Professor of Trauma Medicine from Australia’s top trauma hospital sitting in the jump seat. (Prior to 9/11 it was standard procedure to invite high-valued passengers to share this view).

I suggested that, one day, every surgery would require two similarly-licenced Surgeons and two similarly-licenced Theatre Nurses.

‘That’d be too expensive!’ he exclaimed.

‘Don’t bet on it,’ I said, ‘ one day the insurance companies will make it too expensive to do anything else.’

‘Besides,’ he countered, ‘ … during surgery things happen too fast!’

‘Faster than this?’ as we slowed from 250 knots (500 kph) to 140 knots (280 kph) to start the approach.

‘We are at 3,500 feet going down at 1,500 feet per minute … unless we act - where would we be in three minutes?’

How many bad things can happen during a surgery?

As many as can happen during an approach?

The reason the cockpit is so quiet during the approach is because we discuss all the emergency actions proper to the top of descent.

Standardised key phrases initiate complex emergency procedures.

Will surgeons, diagnosticians, drug-dispensers and nurses ever be required to meet the standards of the airline industry?

Then let's look at all other industries which would benefit from the same standards as imposed on flight crews: interstate truck drivers, train drivers, bus drivers, ship captains, restaurant chefs etc.etc.

The price of compliance is going to be expensive. And maybe nurses will finally get paid what they deserve.



* ”To Err Is Human: Building a Safer Health System (2000)”
Linda T. Kohn, Janet M. Corrigan, and Molla S. Donaldson, Editors
Institute of Medicine (2000). Committee on Quality of Health Care in America



25th July 2001(c)jamesnixon

 
In October 2000 an Australian ABC TV show was sticking the boot into Air Safety.  The internet forum which followed elicited the following postings.


This forum is un-moderated. The views and opinions expressed are those of the individual poster and not the ABC. The ABC reserves the right to remove offensive or inappropriate messages.



James Nixon

 Air safety vs the rest of the world

From:

8/10/00 23:01:55

Subject:

post id: 146971


The Asian Aviation magazine editor recently posed a few interesting questions.

Why are we so paranoid about Asian airline crashes when, compared to everything else, even the Asian airlines (worst record) are miles in front of other areas of human endeavour:

Last year more people died from hand gun deaths in the USA than from ALL worldwide aircraft accidents, shootdowns etc since the end of ww2.

100,000 people died by MIS DIAGNOSIS / MEDICAL HANDLING in hospitals in the USA last year.. . and those are the cases admitted.

He goes on to ask what if the rest of the world applied the same standards as the airline business?

A minimum of two Nurses and two Doctors on every procedure using Crew Resource Management skills.

Plus they would have to undergo checks, like we do, every year:

Medical (1-3 days depending on age), simulator(4 days), emergency procedures (1 day), systems revalidation (half day), line check (4 sectors)

As you remarked about the synergy of a group of Doctors working the problem in the airborne patient, never again would Doctors be allowed to work by themselves again!

Just like us. Imagine it.

Then let's look at all other industries which would benefit from the same standards as imposed on flight crews:

Interstate truckies, bus drivers, ship captains, restaurant chefs, etc.etc.

Interesting thoughts, eh?  -jn



Richard C


Air safety vs the rest of the world

From:

9/10/00 11:59:04

Subject:

post id: 147119


Having had a career in aviation (Air Traffic Control) this comparison of the culture of safety between aviation and other human endeavours is a hobby-horse of mine.

In his post James Nixon allows the possibility that aviation is over cautious, and Dick Smith, with his now infamous "affordable safety" remark obviously considered that it was. I don't think James, who has dedicated his working life to air safety, thinks it is overdone and neither do I. If (as I have) you meet the relatives of the victims of an avoidable air accident, no effort in the pursuit of safety seems too much. Many other areas of work could benefit very much from an examination and emualtion of the training and techniques (both Operational and Management) used in the aviation industry.

I think it is good that people are aware that the risk of air accidents, even though small, is greater in some airline environments than others - it provides a spur to those areas to improve. It is tragic that the same standards of public disclosure an accountability are not applied in other areas. In particular, the medical profession could learn a great deal from the aviation industry.



If I fly Ansett, their safety record is an open book, if I go to the Royal Adelaide Hospital for surgery it is considered an affront to ask how their success rate compares with the Flinders Medical Centre, and the information is not available.


I am often disappointed in the haphazard approach some doctors show to diagnosis, and it is alarming that a doctor who graduated in 1970 has only upgraded his/her knowledge on a voluntary basis and is only subject to a performance check if he/she makes a conspicuous blunder.



Aviation is inherently dangerous (try falling 10Km if you have any doubts) and has only been made into a safe pursuit by the efforts of the people who work in it (pilots, engineers, managers etc.).

Being a human endeavour, aviation is nowhere near perfect, but it stands out as an example of how far we can go if the culture of safety and the protection of human life pervades an industry.


It is an ongoing commitment and there will constantly be those who try to downgrade the efforts, in the interests of "efficiency".



I can't recommend it as away of spending a lunch hour, but standing in silence in the bush with a group of people who wanted to see the place where their relatives had died really focuses you on the need for the Safety Culture.

No, James, I don't think too much is made of it. A billion people will travel by air this year, we could easily see a major hull loss every month, if we hadn't improved since 1960, it would have been 2 a week.


 
(c) jamesnixon.com 2001