Blondes, pilots and doctors. Who should learn from whom?

Blondes, pilots and doctors – who should learn from whom?

The Malaysian Airlines plane disappearance remains a very sad mystery. Our hearts go out to the missing persons and their families/friends, it must be unbearable agony.

Now we hear in the papers that young blonde girls were entertained in the cockpit in 2011 by one of the pilots of missing plane. http://www.dailymail.co.uk/news/article-2578146/Young-blonde-says-missing-Malaysia-Airlines-pilot-invited-friend-ride-cockpit-entire-flight-2011.html

I am not taking any moral stand here, pilots or anyone are welcome to entertain blonde girls or any other type of women or men anywhere. My problem arises when these pilots put passenger safety at risk by such acts.

I heard this news on the morning of 12 March 2014 on my way to the CHFG conference in Birmingham. I would have normally laughed out loud, then stay angered for a while and then move on. But there was something else bothering in my mind. Then at the conference, as in any healthcare conference these days, I heard a number of people repeating what has now become a cliché that healthcare should learn from pilots and airlines. What was bothering me then surfaced to provoke me into writing this blog.

If you thought for a minute that this cockpit privilege is dished out only in Malaysia or in some other distant country, you are probably mistaken and it may be time to change your mind.

A few weeks ago a colleague who is a senior doctor with additional responsibilities in the UK told me about travelling in the cockpit of a major airline on a scheduled short haul international flight in Europe. It was obviously very thrilling for the colleague but as a safety enthusiast it was disturbing me. As a senior doctor it might have been appropriate to decline the offer on the grounds of ensuring safety; that is another debate. If that colleague lied to show off etc that is a personal probity issue.

Then the colleague said that this privilege was also offered to another family member a couple of months earlier, who took a flight in the same sector for stag or a hen night. This is even more unsettling since it seems such behaviour by pilots are not one off or localised but probably frequent and international. Update: Since this blog was originally published about 48 hours ago, I have had a very senior doctor now retired telling me that he sat in the cockpit while flying over the Alps on the way to Italy. Goes to show that it is not only localised and frequent, it is also chronic poor behaviour by pilots.

I think the constant bu*****t about healthcare learning from pilots has to stop. This blog has argued for healthcare to learn from all sorts of good sources. I have previously written about animal air transport. I have written on the pilot error rates not falling since 1950s and the very large variation seen in the 'ultra-safe' airline industry. I still believe that healthcare needs to learn from everyone including airlines. But it should not be one-way traffic. Perhaps pilots can learn from doctors who will not pick out anyone from a waiting room on the basis of hair colour or allow 'friends' to join them in operating theatres as a thrill of the day.

We should not also make the error of mistakenly attributing the improvements allowed by technology as advances in human behaviours and interactions.

©M HEMADRI 

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Scheduled airlines are safe – just like out patient clinics

http://successinhealthcare.blogspot.co.uk/2012/09/scheduled-airlines-are-safe-just-like.html

Healthcare is not similar to aviation but lessons can be learned http://successinhealthcare.blogspot.co.uk/2012/04/healthcare-not-similar-to-aviation-but.html

Checklists in Healthcare - not easy

Checklists in healthcare is not the same as in other industries and is not easy

Checklists are the hot and happening thing in healthcare today, it is to improve the safety and quality of care delivery.

The WHO safe surgery checklist was evolved after good research showed its benefits across the world in reducing deaths and complications. It is a simple one page document. Prof Atul Gawande who pioneered this effort has described the background using construction, airline and other industries as examples.

The checklists as used in industry and by some eminent healthcare providers places seem to be different from the kind of checklists that we do, including the WHO surgical checklist.

In industry checklists are used to define what precisely the work is, in what order the work has to be done – the people who do the work look at it, do the work as it says (execute the work) and tick the box (checklist) to indicate that the work has been done according to the work specification. Often that is the main documentation to record the completion of the work. Here is an example of a construction checklist http://www.sustrans.org.uk/assets/files/guidelines/appendix.pdf I have no special knowledge or affinity to this particular checklist, it simply comes high up on a google search. I encourage you to look at the detail with which the work is specified. I am reliably informed that many construction checklists are even more detailed and project specific. Prof Gawande's book points that in construction work, checklists are done for every component with about 16 different specialities being involved.

In aviation the checklist is aircraft specific. Here is a checklist for a Piper PA28 which is a very small basic plane which is often used to train pilots and it runs to 11 sheets. It is both precise and detailed – it tells you what degree and what RPM to set and so on. The checklist is read out loud and followed every time. It is never 'tick'/'check' marked, never signed and never filed anywhere.

The ‘check’ in industry e.g. construction – is to indicate the tick, cross, ‘check mark’ other marking in the document – a one step process that documents that the defined work is done. In aviation it is a document that is followed but not filed.

The ‘check’ as used by us in healthcare in general and UK in particular – seems to indicate that we need to check (as in inspect/confirm/verify the correctness/hold back/restrain/stop); by the way this is the dictionary definition. This is a two step process – do the work document it and then confirm in a different document that the work is done. The WHO checklist is an additional document – i.e. the antibiotic is ordered and given elsewhere in the process, documented elsewhere and these are confirmed in the checklist; the checklist becomes a supplementary document. This also gains medicolegal importance and adds the bulk of the medical notes. The WHO checklist is allowed to be changed but is often not and where they change it, is still organisation specific and not specialty specific (and never ever patient specific).



When the industry and aviation use detailed and project/plane specific checklists why did healthcare choose to use a single page, generic, general checklist? Clinical medicine and healthcare delivery is obviously more complex than industry or aviation, yet the checklist is a simple single page. The beauty of the WHO checklist lies in its simplicity. It has proven itself under research conditions across the world. However, it is valid to ask whether it is proving itself in real time practice in the NHS. The evidence is not clear yet if there has been a year on year decrease in the incidence of various problems the WHO checklist is supposed to address. The consensus is that the checklist helps.



My personal view is that a one size fits all checklist that the WHO Surgical Checklist is will see its own limitation in time; after all there was a checklist even prior to the WHO one. Procedure specific checklists are the needed urgently - a good example is the matching Michigan checklist for the insertion of central lines. For surgical patients, each patient/procedure should have a customised detailed and specific checklist with an obligation for the surgeon, anaesthetist and their teams to modify the checklist prior to surgery to a patient specific checklist. This empowers the local team members and the process becomes directly relevant to the specific procedure that a specific patient is having on a given day. That is when the power of the checklist seen by Atul Gawande in aviation, construction and finance can truly be realised in healthcare.

©M HEMADRI 

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