Preflight safety briefing: What can healthcare learn from the aviation industry?

October 5, 2010

Over the past week I have seen my fair share of our nation’s airports. After seven flights in six days I am ready for landing by land or sea and will not hesitate to don my oxygen mask before assisting my fellow passengers in doing the same.

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Over the past week I have seen my fair share of our nation’s airports. After seven flights in six days I am ready for landing by land or sea and will not hesitate to don my oxygen mask before assisting my fellow passengers in doing the same.

Whether narrated by the flight attendants or shown as a video on the in-flight entertainment system, the preflight safety briefing is an FAA-mandated, standardized message presented to all airline passengers prior to takeoff. I believe the announcement serves two purposes: 1) it allows passengers to take some ownership of their own safety, and 2) it provides an opportunity for airlines to stress the importance of safety from the moment passengers enter the aircraft.

The aviation industry prides itself on an impeccable safety record. In the past 12 years, the commercial aviation industry has averaged only one fatal crash per two billion person miles flown, a metric that allows comparison with other modes of transportation. Flying is arguably the safest mode of transportation available (though this statistic does little to comfort my wife during the slightest bit of turbulence). However, the industry did not always have such an enviable track record. During the inception of commercial aviation in the 1920s, there were as many as 51 fatal accidents in a single year! So what happened?

In 1926 the U.S. government passed the Air Commerce Act to accomplish three main goals: the rigorous licensing of pilots, formal accident investigation, and the establishment of safety rules and navigation aids under the auspices of the Aeronautics Branch of the Department of Commerce. Since that time, numerous federal agencies have been created to enforce and improve aviation safety including the National Transportation Safety Board (NTSB), Federal Aviation Administration (FAA), and the National Aeronautucs and Space Administration (NASA). However, much of this success can be credited not only to the efforts of these regulatory agencies but also to the development and evolution of a safety culture within the field. Unfortunately, this type of safety culture is generally lacking in healthcare.

While healthcare providers are becoming more cognizant of the effects of medical errors on patient outcomes, a safety culture akin to the one found in aviation is far from a reality. The onus of safety in healthcare is borne almost completely by the provider and not by the patient. I believe that patients should play a greater role in their own safety.

I propose a healthcare model similar to the preflight safety briefing whereby all patients entering a hospital would be advised of certain common safety issues inherent to most healthcare encounters. For example, patients would be instructed to make providers aware of all known allergies and current medications. They could also be urged to make certain each provider washes his or her hands before conducting an examination. A variety of issues could be included in the briefing, but narrowing the list to a few common safety issues and using a standardized method to stress them to each patient during each encounter would help bridge the divide in safety awareness among our patients. My hope is that patients will find it as commonplace to request hand washing by their doctor as airline passengers do to placing their seatback in the upright position and stowing their tray tables during takeoff and landing.

Dr. Krishnaraj is a clinical fellow in the abdominal imaging and intervention division, department of imaging, at Massachusetts General Hospital/Harvard Medical School. He can be reached at akrishnaraj@partners.org.