Are We Finally Learning?

As the BBC post the headline “Air crash investigator to head new health safety body” I am very hopeful. Why?

Aviation safety and psychology may not seem like obvious bedfellows, but they are intricately intertwined. The aviation industry takes human error incredibly seriously, they have to, according to Boeing human error is the cause of 80% of all airline accidents. Take for example the Air France flight 447 that on June 1st 2009 crashed in into the Atlantic Ocean killing all 228 people on board. The cause: human error, the final investigation report reads line after line ‘the crew failed to…’.

Human error covers a fantastic array of factors: tiredness, stress, poor leadership, inadequate communication, dominant personalities influencing group dynamics, poor co-ordination between team members and so the list goes on. The most important aspects in preventing future accidents are recognising the human error, learning about the situation that led to the error and making changes to the way things are done.

In general we are vastly lacking in this form of behavioural learning. At a societal level we do not learn from mistakes and we don’t build on learning from one situation to another. When it comes to behaviour we tend, as a species to make the same mistakes over and over again, generation after generation. And in antipathy to the aviation industry, the medical profession (not just in the UK but worldwide) is a working example of this. For example, in 2000, the BMJ (British Medical Journal) published an international study that looked at the differences in attitude between operating theatre staff and airline cockpit crew. In medicine, surgeons in particular had a dramatically unrealistic view of their fallibility, with 70% believing that they could perform optimally even when they were tired. The aviation industry revealed a more realistic assessment with only 26% of pilots believing they could overcome fatigue. The reality, sleep impairment is biologically equivalent to having alcohol in the blood stream. I don’t know about you but wouldn’t want to get on a plane if the pilot was drunk and I most certainty wouldn’t want to be cut open by a person under the influence. Whilst a fault in the system would have to occur for you to fly with an overtired pilot, the medical systems don’t protect us in the same way. Could this help to explain the fact that in the U.S. up to 98,000 patients die every year as the result of human error?

Aside from the belief of infallibility by medics, errors, when they are made are much less likely to be reported. The BMJ study also found that more than half of medical respondents found it difficult to discuss mistakes and a third of intensive care staff did not even acknowledge that they made any errors. In aviation all mistakes are always analysed and responded to.

The reasons for this are complex, at a simple level there is a stark difference between the nature of errors in the two industries. Airline accidents don’t happen ‘quietly’: a massive object falling from the sky is dramatic, involves a large number of fatalities and attracts a huge amount of media attention. Errors made in the relatively private confines of an operating theatre and interweaved with a multitude of intricate elements, can be brushed under the carpet. But there doesn’t have to be such a stark difference between error reporting in the two occupations. We can learn and progress our understanding of human factors and fallibilities not just in medicine but across all occupations. To do this, passing on knowledge in terms of the systems of error reporting is one crucial factor, but teaching people about behaviour is also critical. If an incredibly well educated surgeon can remain oblivious to the impact of sleep deprivation on their performance, what hope do the rest of us have?

So to sum up, while it’s fantastic that the ‘UK’s chief inspector of air accidents is the leading contender to run a new organisation which aims to make the NHS in England safer.’ it is also critical to recognise that if he is given the job, changes in systems are not going to work until the culture is adapted. Whilst this is a fantastic step in the right direction, to really underpin successfully ‘error recognition’, to make the NHS and other health services safer, the understanding needs to begin at a much earlier stage, being instilled in medical students and then continued through professional development. More broadly speaking to have the same growth and development of society across cultures, children need to be taught about behaviour. This way there is hope that they will grow up with an attitude of self-awareness, willingness to learn from mistakes and a recognition of how things can be improved.

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