Medicine could learn valuable lessons from aviation industry

March 16, 2000

On error management: lessons from aviation

Despite their rarity, the high visibility and often equally large death tolls of plane crashes have forced the aviation industry to take error very seriously.

In this week's BMJ Sexton and colleagues from the Human Factors Research Project at the University of Texas, compared attitudes about error, stress, and teamwork among over 1000 operating and intensive care unit staff and 30 000 airline pilots from around the world.

Consultant surgeons were almost three times as likely as pilots, and consultant anaesthetists almost twice as likely, to deny the effects of fatigue on performance. Virtually all pilots rejected the idea of steep hierarchies, in which senior team members are not open to junior team members' input. But only half of the surgeons did so. Only a third of staff reported that errors were handled appropriately at their hospital. A third of intensive care staff denied making errors at all, but half said they found it difficult to discuss mistakes. The authors conclude that barriers to discussing error become even more important in the face of such levels of denial.

Acknowledging that operating theatres are rather more complex environments than aircraft cockpits, Robert Helmreich, from the Human Factors Research Project at the University of Texas, nevertheless shows that the human and systems approach to error adopted by the aviation industry could be used as a template for medical practice. Unlike medicine, the aviation industry has accepted the inevitability of error, and has invested in non-punitive incident reporting systems and safety audit. Helmreich shows how these provide reliable data to inform training and develop models for the management of error, which focus on human as well as technical performance and include the work environment and professional culture. And he suggests how they could usefully be applied to medical practice.

Bryan Sexton, Human Factors Research Project, University of Texas, USA Email:

Professor Robert Helmreich, Department of Psychology, University of Texas, USA Email:


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